B-Type Natriuretic Peptide in Isolated Severe Tricuspid Regurgitation: Determinants and Impact on Outcome
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Background: The plasma B-type natriuretic peptide (BNP) level is a useful prognostic marker in heart failure and valvular heart disease. In patients with isolated severe tricuspid regurgitation (TR), little is known about the determinants of plasma BNP levels and the correlation with future outcome. The purpose of this study was to identify the determinants of plasma BNP levels in patients with isolated severe TR and the value of the BNP level in predicting postoperative outcomes after corrective surgery. Methods:We prospectively enrolled 39 patients with isolated, severe TR undergoing corrective surgery. A plasma BNP assay and cardiac magnetic resonance (CMR) imaging were performed before surgery. The combined end-point was the occurrence of cardiac death or readmission due to heart failure. Results: Linear regression analysis showed that the left ventricular ejection fraction and right ventricular end systolic volume were the most important determinants of the BNP levels (p = 0.002, R2 = 0.315). Based on the receiver operating characteristics (ROC) curve, we were able to derive an optimal cutoff value (200 pg/mL) to predict postoperative cardiac death with a sensitivity of 80% and a specificity of 85%. The one-year survival rate was 96% in patients with a BNP < 200 pg/mL and 53% in patients with a BNP ≥ 200 pg/dL (p = 0.001). Conclusion: An elevation in the BNP level is determined by the functional status of the right and left ventricles in patients with isolated, severe TR. An elevated BNP predicts adverse events after corrective surgery. Therefore, the BNP level should be included in the clinical evaluation and risk stratification of patients with isolated TR.
Abstract
Background: The plasma B-type natriuretic peptide (BNP) level is a useful prognostic marker in heart failure and valvular heart disease. In patients with isolated severe tricuspid regurgitation (TR), little is known about the determinants of plasma BNP levels and the correlation with future outcome. The purpose of this study was to identify the determinants of plasma BNP levels in patients with isolated severe TR and the value of the BNP level in predicting postoperative outcomes after corrective surgery. Methods:We prospectively enrolled 39 patients with isolated, severe TR undergoing corrective surgery. A plasma BNP assay and cardiac magnetic resonance (CMR) imaging were performed before surgery. The combined end-point was the occurrence of cardiac death or readmission due to heart failure. Results: Linear regression analysis showed that the left ventricular ejection fraction and right ventricular end systolic volume were the most important determinants of the BNP levels (p = 0.002, R2 = 0.315). Based on the receiver operating characteristics (ROC) curve, we were able to derive an optimal cutoff value (200 pg/mL) to predict postoperative cardiac death with a sensitivity of 80% and a specificity of 85%. The one-year survival rate was 96% in patients with a BNP < 200 pg/mL and 53% in patients with a BNP ≥ 200 pg/dL (p = 0.001). Conclusion: An elevation in the BNP level is determined by the functional status of the right and left ventricles in patients with isolated, severe TR. An elevated BNP predicts adverse events after corrective surgery. Therefore, the BNP level should be included in the clinical evaluation and risk stratification of patients with isolated TR.
참고문헌 (20)
- Czer LS, "Tricuspid valve repair. Operative and follow-up evaluation by Doppler color flow mapping", J Thorac Cardiovasc Surg, 98, pp.101~110 (1989)
- Kim HK, "Impact of the maze operation combined with left-sided valve surgery on the change in tricuspid regurgitation over time", Circulation, 112, pp.I14~119 (2005)
- Kim HK, "Assessment of haemodynamic effects of surgical correction for severe functional tricuspid regurgitation: cardiac magnetic resonance imaging study", Eur Heart J, 31, pp.1520~1528 (2010)
- Kim YJ, "Determinants of surgical outcome in patients with isolated tricuspid regurgitation", Circulation, 120, pp.1672~1678 (2009)
- Kuwaki K, "Tricuspid valve surgery for functional tricuspid valve regurgitation associated with left-sided valvular disease", Eur J Cardiothorac Surg, 20, pp.577~582 (2001)
- Kwon DA, "Prediction of outcome in patients undergoing surgery for severe tricuspid regurgitation following mitral valve surgery and role of tricuspid annular systolic velocity", Am J Cardiol, 98, pp.659~661 (2006)
- Staab ME, "Isolated tricuspid valve surgery for severe tricuspid regurgitation following prior left heart valve surgery: analysis of outcome in 34 patients", J Heart Valve Dis, 8, pp.567~574 (1999)
- Kim HK, "Determinants of the severity of functional tricuspid regurgitation", Am J Cardiol, 98, pp.236~242 (2006)
- Mukoyama M, "Brain natriuretic peptide as a novel cardiac hormone in humans. Evidence for an exquisite dual natriuretic peptide system, atrial natriuretic peptide and brain natriuretic peptide", J Clin Invest, 87, pp.1402~1412 (1991)
- Nakagawa M, "Preparation of a monoclonal antibody against mouse brain natriuretic peptide (BNP) and tissue distribution of BNP in mice", Clin Exp Pharmacol Physiol Suppl, 22, pp.S186~187 (1995)
- Ikeda K, "Synthesis of N-acetylglucosaminyl- and N-acetylgalactosaminylceramides as cerebroside analogs and their anti-human immunodeficiency virus type 1 activities", Chem Pharm Bull, 45, pp.402~405 (1997)
- Rademaker MT, "Combined neutral endopeptidase and angiotensin-converting enzyme inhibition in heart failure: role of natriuretic peptides and angiotensin II", J Cardiovasc Pharmacol, 31, pp.116~125 (1998)
- Isnard R, "NT-BNP", BNP for screening left ventricular hypertrophy in hypertension: what else?, 2008, pp.101, 295~297
- Detaint D, "B-type natriuretic peptide in organic mitral regurgitation: determinants and impact on outcome", Circulation, 111, pp.2391~2397 (2005)
- Pizarro R, "Prospective validation of the prognostic usefulness of brain natriuretic peptide in asymptomatic patients with chronic severe mitral regurgitation", J Am Coll Cardiol, 54, pp.1099~1106 (2009)
- Groves PH, "Reduced exercise capacity in patients with tricuspid regurgitation after successful mitral valve replacement for rheumatic mitral valve disease", Br Heart J, 66, pp.295~301 (1991)
- Nath J, "Impact of tricuspid regurgitation on long-term survival", J Am Coll Cardiol, 43, pp.405~409 (2004)
- Vogelsang TW, "Independent effects of both right and left ventricular function on plasma brain natriuretic peptide", Eur J Heart Fail, 9, pp.892~896 (2007)
- Grothues F, "Interstudy reproducibility of right ventricular volumes, function, and mass with cardiovascular magnetic resonance", Am Heart J, 147, pp.218~223 (2004)
- Koskenvuo JW, "Cardiac magnetic resonance imaging in valvular heart disease", Clin Physiol Funct Imaging, 29, pp.229~240 (2009)