B-type Natriuretic Peptide As a Biochemical Marker of Left Ventricular Diastolic Function: Assessment in Asymptomatic Patients 1 Year After Valve Replacement for Aortic Stenosis

Overview

Journal Interact Cardiovasc Thorac Surg

Publisher Oxford University Press

Specialties Cardiology & Vascular Diseases
General Surgery
Pulmonary Medicine

Date 2013 May 10

PMID 23656924

Citations 5

Authors

Vito Mannacio

Anita Antignano

Vincenzo De Amicis

Luigi Di Tommaso

Raffaele Giordano

Gabriele Iannelli

Carlo Vosa

Affiliations

Soon will be listed here.

Abstract

OBJECTIVES Left ventricular (LV) diastolic dysfunction after aortic valve replacement (AVR) carries a substantial risk of development of heart failure and reduced survival. In addition to echocardiography, B-type natriuretic peptide (BNP) provides a powerful incremental assessment of diastolic function. This study evaluates BNP as a marker of LV diastolic dysfunction in a cohort of patients with preserved LV ejection fraction who underwent AVR for pure aortic stenosis and the relationship between BNP values and the grade of LV diastolic dysfunction. METHODS A total of 113 patients were included in the study. Echocardiographic evaluation was performed preoperatively, 5 days postoperatively and at 12-month follow-up, to assess LV dimensional and functional parameters. Diastolic function was labelled as normal, mild, moderate or severe dysfunction. Concomitantly, BNP levels were evaluated. RESULTS Mild to severe diastolic dysfunction occurred preoperatively in all patients. At 12-month follow-up, 65 (62.5%) patients had mild and 25 (24.1%) moderate to severe diastolic dysfunction. BNP values, categorized for quartile distribution, correlated with diastolic dysfunction grade (P<0.001 for each comparison). At receiver operating characteristic analysis, the BNP level of 120 pg/ml was 91% sensitive and 85% specific for diastolic disease, while 300 pg/ml was 80% sensitive and 91% specific for moderate or severe diastolic dysfunction. Twelve months after AVR, BNP values were strongly correlated with the significant echocardiographic parameters suggestive of diastolic dysfunction (P≤0.006 in all cases). CONCLUSIONS The BNP level following AVR is related to diastolic disease severity and may complement echocardiographic evaluation when symptoms are unclear and LV function is difficult to interpret.

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References

Villari B, Vassalli G, Monrad E, Chiariello M, Turina M, Hess O . Normalization of diastolic dysfunction in aortic stenosis late after valve replacement. Circulation. 1995; 91(9):2353-8. DOI: 10.1161/01.cir.91.9.2353. View

Qi W, Mathisen P, Kjekshus J, Simonsen S, Endresen K, Bjornerheim R . The effect of aortic valve replacement on N-terminal natriuretic propeptides in patients with aortic stenosis. Clin Cardiol. 2002; 25(4):174-80. PMC: 6654173. DOI: 10.1002/clc.4960250408. View

Daniels L, Maisel A . Natriuretic peptides. J Am Coll Cardiol. 2007; 50(25):2357-68. DOI: 10.1016/j.jacc.2007.09.021. View

Neverdal N, Knudsen C, Husebye T, Vengen O, Pepper J, Lie M . The effect of aortic valve replacement on plasma B-type natriuretic peptide in patients with severe aortic stenosis--one year follow-up. Eur J Heart Fail. 2006; 8(3):257-62. DOI: 10.1016/j.ejheart.2005.08.004. View

Mannacio V, Tommaso L, De Amicis V, Stassano P, Vosa C . Coronary perfusion: impact of flow dynamics and geometric design of 2 different aortic prostheses of similar size. J Thorac Cardiovasc Surg. 2011; 143(5):1030-5. DOI: 10.1016/j.jtcvs.2011.06.011. View

Michel P, Roques F, Nashef S . Logistic or additive EuroSCORE for high-risk patients?. Eur J Cardiothorac Surg. 2003; 23(5):684-7; discussion 687. DOI: 10.1016/s1010-7940(03)00074-5. View

Lang R, Bierig M, Devereux R, Flachskampf F, Foster E, Pellikka P . Recommendations for chamber quantification: a report from the American Society of Echocardiography's Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of.... J Am Soc Echocardiogr. 2005; 18(12):1440-63. DOI: 10.1016/j.echo.2005.10.005. View

Pedrazzini G, Masson S, Latini R, Klersy C, Rossi M, Pasotti E . Comparison of brain natriuretic peptide plasma levels versus logistic EuroSCORE in predicting in-hospital and late postoperative mortality in patients undergoing aortic valve replacement for symptomatic aortic stenosis. Am J Cardiol. 2008; 102(6):749-54. DOI: 10.1016/j.amjcard.2008.04.055. View

Hashimoto K . Patient-prosthesis mismatch: the Japanese experience. Ann Thorac Cardiovasc Surg. 2006; 12(3):159-65. View

10.

Zoghbi W, Chambers J, Dumesnil J, Foster E, Gottdiener J, Grayburn P . Recommendations for evaluation of prosthetic valves with echocardiography and doppler ultrasound: a report From the American Society of Echocardiography's Guidelines and Standards Committee and the Task Force on Prosthetic Valves, developed in.... J Am Soc Echocardiogr. 2009; 22(9):975-1014. DOI: 10.1016/j.echo.2009.07.013. View

11.

Yarbrough W, Mukherjee R, Ikonomidis J, Zile M, Spinale F . Myocardial remodeling with aortic stenosis and after aortic valve replacement: mechanisms and future prognostic implications. J Thorac Cardiovasc Surg. 2011; 143(3):656-64. PMC: 3210937. DOI: 10.1016/j.jtcvs.2011.04.044. View

12.

Licker M, Cikirikcioglu M, Inan C, Cartier V, Kalangos A, Theologou T . Preoperative diastolic function predicts the onset of left ventricular dysfunction following aortic valve replacement in high-risk patients with aortic stenosis. Crit Care. 2010; 14(3):R101. PMC: 2911741. DOI: 10.1186/cc9040. View

13.

Jourdain P, Jondeau G, Funck F, Gueffet P, Le Helloco A, Donal E . Plasma brain natriuretic peptide-guided therapy to improve outcome in heart failure: the STARS-BNP Multicenter Study. J Am Coll Cardiol. 2007; 49(16):1733-9. DOI: 10.1016/j.jacc.2006.10.081. View

14.

Patel D, Bailey S . Role of BNP in patients with severe asymptomatic aortic stenosis. Eur Heart J. 2004; 25(22):1972-3. DOI: 10.1016/j.ehj.2004.09.001. View

15.

Mannacio V, Tommaso L, Stassano P, De Amicis V, Vosa C . Myocardial metabolism and diastolic function after aortic valve replacement for aortic stenosis: influence of patient-prosthesis mismatch. Eur J Cardiothorac Surg. 2011; 41(2):316-21. DOI: 10.1016/j.ejcts.2011.05.039. View

16.

Zile M, Baicu C, Gaasch W . Diastolic heart failure--abnormalities in active relaxation and passive stiffness of the left ventricle. N Engl J Med. 2004; 350(19):1953-9. DOI: 10.1056/NEJMoa032566. View

17.

Fox A, Shernan S, Collard C, Liu K, Aranki S, DeSantis S . Preoperative B-type natriuretic peptide is as independent predictor of ventricular dysfunction and mortality after primary coronary artery bypass grafting. J Thorac Cardiovasc Surg. 2008; 136(2):452-61. PMC: 2739747. DOI: 10.1016/j.jtcvs.2007.12.036. View

18.

Berger R, Huelsman M, Strecker K, Bojic A, Moser P, Stanek B . B-type natriuretic peptide predicts sudden death in patients with chronic heart failure. Circulation. 2002; 105(20):2392-7. DOI: 10.1161/01.cir.0000016642.15031.34. View

19.

Nagueh S, Appleton C, Gillebert T, Marino P, Oh J, Smiseth O . Recommendations for the evaluation of left ventricular diastolic function by echocardiography. J Am Soc Echocardiogr. 2009; 22(2):107-33. DOI: 10.1016/j.echo.2008.11.023. View

20.

Ha J, Oh J, Redfield M, Ujino K, Seward J, Tajik A . Triphasic mitral inflow velocity with middiastolic filling: clinical implications and associated echocardiographic findings. J Am Soc Echocardiogr. 2004; 17(5):428-31. DOI: 10.1016/j.echo.2004.02.007. View