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B-type natriuretic peptide in organic mitral regurgitation: determinants and impact on outcome.
Circulation. 2005 May 10; 111(18):2391-7.Circ

Abstract

BACKGROUND

B-type natriuretic peptide (BNP) activation observed in cardiac diseases is a predictor of poor outcome; however, in organic mitral regurgitation (MR), BNP determinants and prognostic value are unknown.

METHODS AND RESULTS

We prospectively enrolled 124 patients with chronic organic MR (aged 63+/-15 years, 60% males) in whom we measured BNP level and simultaneously quantified MR degree, left ventricular (LV) remodeling, and left atrial (LA) volumes and analyzed long-term outcome. Baseline BNP level (54+/-67 pg/mL, median 31 pg/mL) was associated univariately with multiple clinical and echocardiographic characteristics, but in multivariate analysis, independent determinants of BNP, beyond age and sex (both P< or =0.01), were LV end-systolic volume index, LA volume, atrial fibrillation, and symptoms (all P<0.02). Conversely, MR degree was not independently associated with BNP. During follow-up, patients with high versus low BNP (> or =31 versus <31 pg/mL) displayed lower survival rates (at 5 years, 72+/-10% versus 95+/-5%, P=0.03) and higher rates of the combined end point of death and heart failure (at 5 years, 42+/-10% versus 16+/-7%, P=0.03). In multivariate analysis, with adjustment for age, sex, functional class, MR severity, and ejection fraction, BNP was independently predictive of mortality (hazard ratio per 10 pg/mL, 1.23 [95% CI 1.07 to 1.48], P=0.004) and of death or heart failure (hazard ratio per 10 pg/mL, 1.09 [95% CI 1.001 to 1.19], P=0.04).

CONCLUSIONS

BNP activation in organic MR reflects primarily ventricular and atrial consequences rather than degree of MR. Higher BNP level in patients with organic MR independently predicts adverse events under conservative management. Therefore, BNP activation in organic MR is an emerging biomarker of severity of MR consequences and of poor clinical outcome, and its assessment should be considered in the clinical evaluation and risk stratification of patients with MR.

Authors+Show Affiliations

Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minn 55905, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

15883225

Citation

Detaint, Delphine, et al. "B-type Natriuretic Peptide in Organic Mitral Regurgitation: Determinants and Impact On Outcome." Circulation, vol. 111, no. 18, 2005, pp. 2391-7.
Detaint D, Messika-Zeitoun D, Avierinos JF, et al. B-type natriuretic peptide in organic mitral regurgitation: determinants and impact on outcome. Circulation. 2005;111(18):2391-7.
Detaint, D., Messika-Zeitoun, D., Avierinos, J. F., Scott, C., Chen, H., Burnett, J. C., & Enriquez-Sarano, M. (2005). B-type natriuretic peptide in organic mitral regurgitation: determinants and impact on outcome. Circulation, 111(18), 2391-7.
Detaint D, et al. B-type Natriuretic Peptide in Organic Mitral Regurgitation: Determinants and Impact On Outcome. Circulation. 2005 May 10;111(18):2391-7. PubMed PMID: 15883225.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - B-type natriuretic peptide in organic mitral regurgitation: determinants and impact on outcome. AU - Detaint,Delphine, AU - Messika-Zeitoun,David, AU - Avierinos,Jean-François, AU - Scott,Christopher, AU - Chen,Horng, AU - Burnett,John C,Jr AU - Enriquez-Sarano,Maurice, PY - 2005/5/11/pubmed PY - 2006/1/18/medline PY - 2005/5/11/entrez SP - 2391 EP - 7 JF - Circulation JO - Circulation VL - 111 IS - 18 N2 - BACKGROUND: B-type natriuretic peptide (BNP) activation observed in cardiac diseases is a predictor of poor outcome; however, in organic mitral regurgitation (MR), BNP determinants and prognostic value are unknown. METHODS AND RESULTS: We prospectively enrolled 124 patients with chronic organic MR (aged 63+/-15 years, 60% males) in whom we measured BNP level and simultaneously quantified MR degree, left ventricular (LV) remodeling, and left atrial (LA) volumes and analyzed long-term outcome. Baseline BNP level (54+/-67 pg/mL, median 31 pg/mL) was associated univariately with multiple clinical and echocardiographic characteristics, but in multivariate analysis, independent determinants of BNP, beyond age and sex (both P< or =0.01), were LV end-systolic volume index, LA volume, atrial fibrillation, and symptoms (all P<0.02). Conversely, MR degree was not independently associated with BNP. During follow-up, patients with high versus low BNP (> or =31 versus <31 pg/mL) displayed lower survival rates (at 5 years, 72+/-10% versus 95+/-5%, P=0.03) and higher rates of the combined end point of death and heart failure (at 5 years, 42+/-10% versus 16+/-7%, P=0.03). In multivariate analysis, with adjustment for age, sex, functional class, MR severity, and ejection fraction, BNP was independently predictive of mortality (hazard ratio per 10 pg/mL, 1.23 [95% CI 1.07 to 1.48], P=0.004) and of death or heart failure (hazard ratio per 10 pg/mL, 1.09 [95% CI 1.001 to 1.19], P=0.04). CONCLUSIONS: BNP activation in organic MR reflects primarily ventricular and atrial consequences rather than degree of MR. Higher BNP level in patients with organic MR independently predicts adverse events under conservative management. Therefore, BNP activation in organic MR is an emerging biomarker of severity of MR consequences and of poor clinical outcome, and its assessment should be considered in the clinical evaluation and risk stratification of patients with MR. SN - 1524-4539 UR - https://www.unboundmedicine.com/medline/citation/15883225/B_type_natriuretic_peptide_in_organic_mitral_regurgitation:_determinants_and_impact_on_outcome_ L2 - http://www.ahajournals.org/doi/full/10.1161/01.CIR.0000164269.80908.9D?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -