The Effect of Percutaneous Balloon Mitral Valvuloplasty on N-Terminal- Pro B- Type Natriuretic Peptide Plasma Levels in Mitral Stenosis

Abstract

SUMMARYThe objectives of this study were to assess the effect of percutaneous mitral balloon valvuloplasty (PBMV) on the plasma levels of N-terminal-pro B-type natriuretic peptide (NT-proBNP) in patients with mitral stenosis (MS) and to investigate the relationship between the changes in hemodynamic variables and NT-proBNP levels after PBMV. Plasma NT-proBNP concentrations were obtained from 60 symptomatic patients with rheumatic MS who underwent PBMV, and in 35 age-and gender-matched healthy volunteers. Patients with MS were found to have significantly higher levels of plasma NTproBNP compared to the control group (293 [77-1093] pg/mL versus 24 [12-67] pg/mL, respectively; [P < 0.001]). The mean preprocedural NT-proBNP level fell significantly from 293 (77-1093) pg/mL to 214 (69-1028) pg/mL (P < 0.001) following PBMV. The percentage decrease in plasma NT-proBNP levels was correlated only with the percentage decrease in systolic pulmonary artery pressure (r = 0.687, P < 0.001) and this correlation persisted in linear regression analysis (β = -0.013; 95% CI [-0.018--0.008] and P < 0.001). However, NT-proBNP levels did not correlate with the percentage of improvement in NYHA functional class, mitral valve gradients, or left atrial pressure (all P > 0.05). These findings indicate that NT-proBNP measurement following PBMV may be valuable for evaluating changes in pulmonary artery pressure and that elevated NTproBNP levels in patients with MS may reflect the increased wall stress in the left atrium and right side of the heart. (Int Heart J 2007; 48: 579-590) Key words: Mitral balloon, NT-proBNP, Pulmonary hypertension BRAIN natriuretic peptide (BNP) is a member of the natriuretic peptide family that has regulatory and modulatory roles in the cardiovascular system 1) including natriuresis, diuresis, and vasodilatation.

ANP and BNP plasma levels in patients with rheumatic mitral stenosis after percutaneous balloon mitral valvuloplasty

“…Moreover, it has been demonstrated that higher ANP and BNP levels were associated with the severity of mitral stenosis according to echocardiography (lower MVA, higher PMG and MGM) and hemodynamics (higher PCWP and lower CO). Previous studies also reported the association between increased BNP levels and elevated NYHA class, higher PAP as well as more severe mitral stenosis according to echocardiography [34, 35]. …”

“…Many papers describe the neurohormonal changes as consequences of hemodynamic alterations after PBMV [26, 27]. Those reports are based on the results collected in the first few days after the procedure.…”

The Impact of Right Ventricular Stroke Work on B‐Type Natriuretic Peptide Levels in Patients With Mitral Stenosis Undergoing Percutaneous Mitral Valvuloplasty

“…BNP levels also correlate with LV filling pressures in patients with depressed systolic function . Although LV myocardium was thought to constitute the major source of BNP, some studies have raised the possibility of other sites within the heart where synthesis or secretion of BNP occurs. In patients with MS and normal LV function, baseline serum BNP is elevated although not as high as those seen in cases of decompensated left heart failure, suggesting a possible alternative pathophysiological mechanisms for BNP production.…”

Comparison of Atrial and Brain Natriuretic Peptide for the Assessment of Mitral Stenosis

“…These observations suggest that ANP may be more useful than BNP the haemodynamic consequences of MS [6]. Several studies however have reported associations between both ANP [7-9] and BNP [10][11][12][13] and echocardiographic measures of MS severity, including mitral valve area, left atrial size and pulmonary artery pressure. These studies did not include an objective evaluation of exercise capacity, comparison against guidelines for intervention or clinical follow-up for outcomes.…”

“…Whilst increased BNP secretion from the right ventricle is also possible, there was no association between plasma BNP and right ventricular size or systolic function either at rest or post exercise. Several previous studies have reported similar associations between plasma ANP, BNP and N-terminal pro-BNP and echocardiographic measures of MS severity [10][11][12][13]. However, these studies did not include stress echocardiography, an objective assessment of exercise capacity, or evaluation of outcomes during follow-up.…”