Change of B-Type Natriuretic Peptide After Surgery and Its Association With Rhythm Status in Patients With Chronic Severe Mitral Regurgitation

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• 作者：In-Chang Hwang ; MD^a ; ^b ; Dae-Hee Kim ; MD^a ; ^b ; Yong-Jin Kim ; MD^a ; ^b ; ^{kimdamas@snu.ac.kr} ; Kyung-Hee Kim ; MD^a ; ^b ; Seung-Pyo Lee ; MD^a ; ^b ; Hyung-Kwan Kim ; MD^a ; ^b ; Dae-Won Sohn ; MD^a ; ^b ; Byung-Hee Oh ; MD^a ; ^b ; Young-Bae Park ; MD^a ; ^b
• 刊名：Canadian Journal of Cardiology
• 出版年：2013
• 出版时间：June, 2013
• 年：2013
• 卷：29
• 期：6
• 页码：704-711
• 全文大小：709 K

文摘

Background

B-type natriuretic peptide (BNP) is a useful biomarker of cardiac function in patients with mitral regurgitation (MR). However, the change in BNP in association with rhythm status after corrective surgery has not been studied.

Methods

A total of 101 patients with chronic severe MR undergoing surgery were prospectively enrolled. BNP assays and echocardiographic studies were conducted before and 6 months after surgery. Patients were divided into 3 groups according to pre- and postoperative rhythm (sinus to sinus [SS], n?= 61; atrial fibrillation [AF] to sinus [AS], n?= 28; AF to AF [AA], n?= 12).

Results

BNP decreased only in the AS group 6 months after mitral surgery (from 218.0 ¡À 136.5 to 94.7 ¡À 85.1 pg/mL; P < 0.001) but not in the SS or AA groups (P for interaction?= 0.001). However, changes of echocardiographic parameters after surgery were not different among the 3 groups. In the AA group, postoperative left ventricular (LV) end-diastolic dimension and left atrial volume were higher than the other groups. Significant determinants of BNP were the presence of AF and the higher pulmonary artery systolic pressure preoperatively (¦Â?= 0.767 and P?= 0.001 for AF; ¦Â?= 0.022 and P?= 0.019 for pulmonary artery systolic pressure), and the lower LV ejection fraction postoperatively (¦Â?=??0.030; P?= 0.011).

Conclusions

After surgical correction of chronic organic severe MR,?BNP decreased only in patients with preoperative AF which was converted to sinus rhythm postoperatively. A reduction in BNP was not observed when rhythm status did not change. BNP activation was associated with the presence of AF and LV systolic dysfunction, suggesting its prognostic value.