Association of B-Type Natriuretic Peptide With Survival in Patients With Degenerative Mitral Regurgitation

Clavel, Marie‐Annick; Tribouilloy, Christophe; Vanoverschelde, J.-L.; Pizarro, Rodolfo; Suri, Rakesh M.; Szymanski, Catherine; Lazam, Siham; Oberti, Pablo; Michelena, Héctor I.; Jaffe, Allan S.; Enríquez-Sarano, Maurice

doi:10.1016/j.jacc.2016.06.047

Cited by 44 publications

(23 citation statements)

References 36 publications

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“…On the other hand, BNP activation was not an independent indicator of survival in the group who had surgery. Another significant finding from this study was that patients with non-elevated BNP activation (BNP £1) had better prognosis (264). If the patients with asymptomatic severe MR do not have the criteria for surgical intervention and the BNP ratio is low, conservative follow-up of these patients is a very safe approach.…”

Section: Mitral Regurgitationmentioning

confidence: 71%

“…If the patients with asymptomatic severe MR do not have the criteria for surgical intervention and the BNP ratio is low, conservative follow-up of these patients is a very safe approach. Moreover, if surgical intervention indication occurs in a patient and BNP activation also increases in patients, it is still possible to obtain better long-term results with surgical intervention in such patients (264).…”

Section: Mitral Regurgitationmentioning

confidence: 99%

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Natriuretic Peptides in Clinical Practice

Çavuşoğlu

Alper²,

Altay³

et al. 2019

Anatol J Cardiol

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Natriuretic peptides (NP) are commonly used diagnostic biomarkers in heart failure (HF). While the American HF guideline strongly recommends NPs as class I indication with the level of evidence A in the diagnosis of both acute and chronic HF (1), the European HF guideline recommends them as class I indicationwith the level of evidence A for acute HF and as class IIa indication with the level of evidence C for chronic HF (2). Similarly, NPs have been proven to be strong biomarkers for prognosis and risk assessment in HF. The American HF guideline recommends NPs as class I indication with the level of evidence A in the assessment of prognosis of both acute and chronic HF (1). Moreover, the American HF guideline recommends NP monitorization as class IIa indication with the level of evidence B for achieving optimal treatment target in chronic HF (1). However, it Natriuretic peptides have long been introduced into clinical practice. These biomarkers have certainly been shown to provide useful information in the diagnosis, prognosis and risk stratification in heart failure and also may have a role in the guidance of heart failure therapy. Although, there are some limitations in using of these markers such as lack of specificity, aging, renal dysfunction or obesity, among the huge number of candidates for heart failure biomarkers, only natriuretic peptides are currently widely used in daily clinical practice in heart failure. Recent heart failure guidelines recognize natriuretic peptides as an essential tool in the new diagnostic and therapeutic algorithms. Furthermore, natriuretic peptides are not only used in the diagnosis or prognosis of heart failure, but also these biomarkers are referred to have some potential role in primary prevention, cardio-oncology, advanced heart failure, assessment of response to cardiac resynchronization therapy, pulmonary arterial hypertension, acute coronary syndromes, atrial fibrillation and valvular heart disease. In this article, natriuretic peptides have been reviewed for their updated information and new recommendations in heart failure and also potential role of these biomarkers in the management of various clinical conditions have been addressed in the form of expert opinion based on the available data in the literature.

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Section: Mitral Regurgitationmentioning

confidence: 71%

Section: Mitral Regurgitationmentioning

confidence: 99%

Natriuretic Peptides in Clinical Practice

Çavuşoğlu

Alper²,

Altay³

et al. 2019

Anatol J Cardiol

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“…The use of cardiac stretch biomarkers, such as B-type natriuretic peptide, can be useful to monitor patients with primary organic MR, with high values predicting mortality. 43 Higher values are also associated with increased MR severity and mortality in patients with ischemic MR, although elevated levels in this population can also be caused by LV dysfunction and does not always reflect MR severity. Despite encouraging results in predicting secondary MR response after CRT, the clinical applicability of newer biomarkers (sST2, galectin 3) remains to be studied in larger trials.…”

Section: Biomarkersmentioning

confidence: 93%

Pathophysiology, Diagnosis, and New Therapeutic Approaches for Ischemic Mitral Regurgitation

Hadjadj

Marsit

Paradis

et al. 2021

Canadian Journal of Cardiology

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Ischemic mitral regurgitation (MR) is a valvular complication frequently seen in patients with coronary artery disease and is associated with increased mortality and morbidity. Ischemic mitral regurgitation has a complex, heterogeneous, and still incompletely understood pathophysiology involving both the mitral valve and the left ventricle. The occurrence of valve regurgitation in patients with ischemic cardiomyopathy in return accelerates left ventricular remodelling and dysfunction, ultimately leading to irreversible heart failure. Diagnostic evaluation of ischemic MR is unique and different from the other causes of MR. The severity thresholds associated with outcomes are different from primary MR, and specific imaging characteristics are potentially useful to guide therapy. The use of imaging modalities such as 3-dimensional echocardiography and cardiac magnetic resonance R ESUM E

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Section: Nps and Risk Assessment In Mrmentioning

confidence: 99%

“…This parameter behaves as a significant independent prognostic marker of outcomes in valve heart disease patients, including MR patients under medical treatment [28,29]. However, it failed to maintain its role after surgery [28]. Interestingly, the BNP/ANP ratio revealed a prognostic role in one study, being significantly higher in the presence of clinical and echocardiographic criteria used for surgery recommendation, such as LVESD ≥ 45 mm, LVEF ≤ 60%, NYHA class II or greater, and AF [30].…”

Section: Nps and Risk Assessment In Mrmentioning

confidence: 99%

Functional Role of Natriuretic Peptides in Risk Assessment and Prognosis of Patients with Mitral Regurgitation

Gallo

Forte

Stanzione

et al. 2020

JCM

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The management of mitral valve regurgitation (MR), a common valve disease, represents a challenge in clinical practice, since the indication for either surgical or percutaneous valve replacement or repair are guided by symptoms and by echocardiographic parameters which are not always feasible. In this complex scenario, the use of natriuretic peptide (NP) levels would serve as an additive diagnostic and prognostic tool. These biomarkers contribute to monitoring the progression of the valve disease, even before the development of hemodynamic consequences in a preclinical stage of myocardial damage. They may contribute to more accurate risk stratification by identifying patients who are more likely to experience death from cardiovascular causes, heart failure, and cardiac hospitalizations, thus requiring surgical management rather than a conservative approach. This article provides a comprehensive overview of the available evidence on the role of NPs in the management, risk evaluation, and prognostic assessment of patients with MR both before and after surgical or percutaneous valve repair. Despite largely positive evidence, a series of controversial findings exist on this relevant topic. Recent clinical trials failed to assess the role of NPs following the interventional procedure. Future larger studies are required to enable the introduction of NP levels into the guidelines for the management of MR.

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Association of B-Type Natriuretic Peptide With Survival in Patients With Degenerative Mitral Regurgitation

Abstract: 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.

Cited by 44 publications

References 36 publications

Natriuretic Peptides in Clinical Practice

Natriuretic Peptides in Clinical Practice

Pathophysiology, Diagnosis, and New Therapeutic Approaches for Ischemic Mitral Regurgitation

Functional Role of Natriuretic Peptides in Risk Assessment and Prognosis of Patients with Mitral Regurgitation

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