title: Association of B-Type Natriuretic Peptide With Survival in Patients With Degenerative Mitral Regurgitation.
abstract: Studies suggesting that B-type natriuretic peptide (BNP) may predict outcomes of mitral regurgitation (MR) are plagued by small size, inconsistent etiologies, and lack of accounting for shifting normal BNP ranges with age and sex.
  
  
  
  This study assessed the effect of BNP activation on mortality in a large, multicenter cohort of patients with degenerative MR.
  
  
  
  In 1,331 patients with degenerative MR, BNP was prospectively measured at diagnosis and expressed as BNPratio (ratio to upper limit of normal for age, sex, and assay). Initial surgical management was performed within 3 months of diagnosis in 561 patents.
  
  
  
  The cohort had a mean age of 64 ± 15 years, was 66% male, and had a mean ejection fraction 64 ± 9%, mean regurgitant volume 67 ± 31 ml, and low mean Charlson comorbidity index of 1.09 ± 1.76. Median BNPratio was 1.01 (25th and 75th percentiles: 0.42 to 2.36). Overall, BNPratio was a powerful, independent predictor of mortality (hazard ratio: 1.33 [95% confidence interval: 1.15 to 1.54]; p < 0.0001), whereas absolute BNP was not (p = 0.43). In patients who were initially treated medically (n = 770; 58%), BNPratio was a powerful, independent, and incremental predictor of mortality after diagnosis (hazard ratio: 1.61 [95% confidence interval: 1.34 to 1.93]; p < 0.0001). Higher BNP activation was associated with higher mortality (p < 0.0001). All subgroups, particularly severe MR, incurred similar excess mortality with BNP activation. After initial surgical treatment (n = 561, 42%) BNP activation did not impose excess long-term mortality (p = 0.23).
  
  
  
  In patients with degenerative MR, BNPratio is a powerful, independent, and incremental predictor of long-term mortality under medical management. BNPratio should be incorporated into the routine clinical assessment of patients with degenerative MR.
authors.affiliation: Department of Cardiology, Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minnesota.
authors.forename: Marie-Annick
authors.initials: MA
authors.lastname: Clavel
authors.affiliation: Department of Cardiology, INSERM, ERI-12, University Hospital, Amiens, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Tribouilloy
authors.affiliation: Department of Cardiology, Université Catholique de Louvain, Brussels, Belgium.
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Vanoverschelde
authors.affiliation: Department of Cardiology, Hospital Italiano, Buenos Aires, Argentina.
authors.forename: Rodolfo
authors.initials: R
authors.lastname: Pizarro
authors.affiliation: Department of Cardiology, Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minnesota.
authors.forename: Rakesh M
authors.initials: RM
authors.lastname: Suri
authors.affiliation: Department of Cardiology, INSERM, ERI-12, University Hospital, Amiens, France.
authors.forename: Catherine
authors.initials: C
authors.lastname: Szymanski
authors.affiliation: Department of Cardiology, Université Catholique de Louvain, Brussels, Belgium.
authors.forename: Siham
authors.initials: S
authors.lastname: Lazam
authors.affiliation: Department of Cardiology, Hospital Italiano, Buenos Aires, Argentina.
authors.forename: Pablo
authors.initials: P
authors.lastname: Oberti
authors.affiliation: Department of Cardiology, Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minnesota.
authors.forename: Hector I
authors.initials: HI
authors.lastname: Michelena
authors.affiliation: Department of Cardiology, Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minnesota.
authors.forename: Allan
authors.initials: A
authors.lastname: Jaffe
authors.affiliation: Department of Cardiology, Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minnesota. Electronic address: Sarano.maurice@mayo.edu.
authors.forename: Maurice
authors.initials: M
authors.lastname: Enriquez-Sarano
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000097:blood* / Q000401:mortality* / Q000601:surgery; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D011446:Prospective Studies; D015996:Survival Rate
chemical_list: D020097:Natriuretic Peptide, Brain
keywords: Doppler echocardiography; brain natriuretic peptide; degenerative mitral regurgitation; survival; valvular heart disease