Prospective Validation of the Prognostic Usefulness of Brain Natriuretic Peptide in Asymptomatic Patients With Chronic Severe Mitral Regurgitation

Abstract

Among patients with severe asymptomatic organic mitral regurgitation, BNP > or =105 pg/ml discriminates a subgroup of patients at higher risk. Because of its incremental prognostic value, BNP assessment should be considered in clinical routine workup for risk stratification.

Guía ESC/EACTS 2017 sobre el tratamiento de las valvulopatías

“…Más específicamente, las concentraciones plasmá-ticas de BNP bajas tienen valor predictivo negativo y su determinación puede ser útil en el seguimiento de pacientes asintomáticos 120 . Debido a las discrepancias que existen entre las mediciones ecocardiográficas y las invasivas de la presión pulmonar, si esta fuese la única indicación para cirugía, la medición debe confirmarse de manera invasiva mediante cateterismo de corazón derecho.…”

Natriuretic Peptides for Risk Stratification of Patients With Valvular Aortic Stenosis

“…Although the discussion of this topic is beyond the scope of this review, natriuretic peptides correlate with the severity of regurgitation, 25,42 LV remodeling and dysfunction, [43][44][45] symptomatic status, 46,47 and mortality 45,48 in mitral regurgitation and aortic regurgitation.…”

Mitral Valve Prolapse With Mid-Late Systolic Mitral Regurgitation

“…Our study shows that, in regard to these criteria, mid-late systolic MR and holosystolic MR have a similar appearance by color Doppler, and recognizing that these characteristics are only present for part of systole is not easy. Because of the pitfalls of color Doppler, quantitative assessment is recommended, 15 and a large ERO is now recognized in clinical guidelines as a major marker of severe MR. 8 This recognition is based on the association of ERO with the physiological consequences of MR 35 and the clinical outcome in several prospective studies of organic MR. [12][13][14]16 The power of ERO as a determinant of outcome is related to the fact that LV energy is transmitted to the LA 36 not just as regurgitant volume but also as potential energy (pressure), so that ERO is associated with subsequent heart failure and cardiac events. 12 ERO and regurgitant volume are measurable by several methods, 15 and the flow convergence method has been validated 24,37 with excellent correlations to quantitative Doppler.…”

“…Indeed, these methods are sensitive in detecting MR progression, 11 and effective regurgitant orifice (ERO) has been shown in several large prospective series to be independently and strongly associated with outcome under medical management. [12][13][14] An ERO Ն40 mm 2 is now recognized by most scientific societies as the threshold for defining severe MR 8,15 and is associated with high mortality (in excess of that expected in the population) and with frequent cardiac events. 12,16 …”