The Impact of Right Ventricular Stroke Work on B‐<scp>T</scp>ype Natriuretic Peptide Levels in Patients With Mitral Stenosis Undergoing Percutaneous Mitral Valvuloplasty

Esteves, William A. M.; Lodi-Junqueira, Lucas; Neto, Cirilo P. Fonseca; Tan, Timothy C.; Nascimento, Bruno Ramos; Mehrotra, Praveen; Barbosa, Márcia M.; Ribeiro, Antônio Luiz Pinho; Nunes, Maria Carmo Pereira

doi:10.1111/joic.12050

Cited by 10 publications

(17 citation statements)

References 29 publications

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“…Plasma BNP concentrations are elevated in MS in response to LA pressure overload and pulmonary hypertension, which decline with successful PMV . We previously showed that reduction of LA pressure after relief of obstruction was associated with a decrease in BNP levels . Although we expected that increase in C a would result in a decrease in atrial pressure as well as in wall stretch with consequent reduction in BNP levels, in this study changes in C a were not correlated to reduction of BNP.…”

Section: Discussioncontrasting

confidence: 53%

“…31 We previously showed that reduction of LA pressure after relief of obstruction was associated with a decrease in BNP levels. 32 Although we expected that increase in C a would result in a decrease in atrial pressure as well as in wall stretch with consequent reduction in BNP levels, in this study changes in C a were not correlated to reduction of BNP. However, the negative correlation between post PMV BNP concentration and C v indicates that post procedural ventricular compliance may influence BNP release.…”

Section: Changes In Net Chamber Compliance and Bnp Levels Followingmentioning

confidence: 55%

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Impact of left atrial compliance improvement on functional status after percutaneous mitral valvuloplasty

Athayde

Nascimento

Elmariah

et al. 2018

Cathet Cardio Intervent

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Background Conventional hemodynamic parameters may not accurately predict symptomatic improvement after percutaneous mitral valvuloplasty (PMV). Changes in left heart chamber compliance following adequate relief o0066 mitral stenosis (MS) may be useful in determining functional capacity after PMV. This study aims to determine the acute effects of PMV on compliance of the left heart and whether its changes relate to the patient's functional capacity. Methods One‐hundred thirty‐seven patients with severe MS undergoing PMV were enrolled. Left atrial (Ca) and left ventricular (Cv) compliance were invasively estimated and net atrioventricular compliance (Cav) was calculated before and immediately after the procedure. B‐type natriuretic peptide (BNP) levels were obtained before and 24 hr after the procedure. The primary endpoint was functional status at 6‐month follow‐up, and the secondary endpoint was a composite of death, mitral valve (MV) replacement, repeat PMV, new onset of atrial fibrillation, or stroke in patients in whom PMV was successful. Results The mean age was 43 ± 12 years, and 119 patients were female (87%). After PMV, Ca and Cav improved significantly from 5.3 [IQR 3.2–8.2] mL/mmHg to 8.7 [5.3–19.2] mL/mmHg (P < 0.001) and 2.2 [1.6–3.4] to 2.8 [2.1–4.1] mL/mmHg (P < 0.001), respectively, whereas Cv did not change (4.6 [3.2–6.8] to 4.4 [3.1–5.6]; P = 0.637). Plasma BNP levels significantly decreased after PMV, with no correlation between its variation and changes in left chamber compliance. At 6‐month follow‐up, NYHA functional class remained unchanged in 32 patients (23%). By multivariable analyses, changes in Ca immediately after PMV (adjusted OR 1.42; 95% CI 95% 1.02 to 1.97; P = 0.037) and younger age (adjusted OR 0.95; CI 95% 0.92–0.98; P = 0.004), predicted improvement in functional capacity at 6‐month follow‐up, independent of postprocedural data. The secondary endpoint were predicted by post‐PMV mean gradient (adjusted HR 1.363; 95% CI 95% 1.027–1.809; P = 0.032), and lack of functional improvement at 6‐month follow‐up (adjusted HR 4.959; 95% 1.708–14.403; P = 0.003). Conclusions Ca and Cav increase significantly after PMV with no change in Cv. The improvement of Ca is an important predictor of functional status at 6‐month follow up, independently of other hemodynamic data. Postprocedural mean gradient and lack of short‐term symptomatic improvement were predictors of adverse outcome.

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Section: Discussioncontrasting

confidence: 53%

Section: Changes In Net Chamber Compliance and Bnp Levels Followingmentioning

confidence: 55%

Impact of left atrial compliance improvement on functional status after percutaneous mitral valvuloplasty

Athayde

Nascimento

Elmariah

et al. 2018

Cathet Cardio Intervent

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“…In this context, assessment of biomarkers that reflect immediate hemodynamic improvement seems to be a good indicator of PMC success, and less subject to variability than TTE. Data are controversial regarding the utility of more widely used biomarkers, such as BNP and NT-proBNP, to assess the success of PMC, precluding their use as a reliable indicator in this context [22,[24][25][26]. Our results suggest that the drop in sCD146 and MR-proANP could indicate immediate procedural success after PMC, reflecting the hemodynamic improvement achieved by the procedure, especially since the magnitude of the drop in sCD146 is related to the benefit yielded by the PMC.…”

Section: Discussionmentioning

confidence: 99%

Assessment of successful percutaneous mitral commissurotomy by MRproANP and sCD146

Badoz

Arrigo

Mogenet

et al. 2020

BMC Cardiovasc Disord

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Background: We studied the course of plasma concentrations of 4 cardiovascular biomarkers: natriuretic peptides (BNP, NT-proBNP; mid-regional (MR) pro-atrial NP); and soluble endothelial CD146 (sCD146), in patients with severe mitral valve stenosis undergoing percutaneous mitral commissurotomy (PMC) to identify potential markers of procedural success. Methods: Biomarkers were tested in 40 patients the day before and the day after PMC. Success was defined as mitral valve area ≥ 1.5 cm 2 ; or an increase of ≥0.5 cm2 in mitral valve area associated with echocardiographic mitral regurgitation

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“…3,4 B-type natriuretic peptide (BNP) is a neurohormone secreted in both the left ventricle (LV) and RV in response to volume expansion 5 and pressure overload. 6 N-terminal prohormone BNP (NT-proBNP) is a cleaved byproduct of BNP, 7 which has a longer in vivo half-life 8 and offers numerous logistical advantages for clinical monitoring. 2 Serum biomarker expression has been shown to be a better indicator of outcome than mPAP, 3 with the diagnostic value of BNP and NT-proBNP well established in symptomatic and asymptomatic 9 heart failure.…”

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confidence: 99%

Assessment of N‐Terminal Prohormone B‐Type Natriuretic Peptide as a Measure of Vascular and Ventricular Function in Pediatric Pulmonary Arterial Hypertension

et al. 2015

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Pulmonary arterial hypertension (PAH) is a progressive disease that puts excessive mechanical loads on the ventricle due to a gradual increase in pulmonary vascular impedance. We hypothesize that the increase in right ventricular (RV) afterload is reflected in the concentration of circulating biochemical markers of ventricular strain and stress (B-type natriuretic peptide [BNP] and N-terminal prohormone BNP [NT-proBNP]). We retrospectively analyzed right heart catheterization (RHC) and serum biochemical analysis data ([Formula: see text]) for a pediatric PAH cohort with no sign of left ventricular dysfunction. Using RHC data, we computed an estimate of pulmonary vascular resistance (PVR), compliance, and ventricular-vascular coupling. We also compared how the early onset of interventricular decoupling (characterized as septal flattening) impacts serum NT-proBNP concentrations. Our data revealed correlated NT-proBNP expression with both the resistive and reactive components of RV afterload, an estimate of ventricular-vascular coupling, and a significant increase in biomarker expression in patients with a flattened interventricular septum. Furthermore, the strong correlation between PVR and NT-proBNP appears to break down under flat septum morphology. Over 80% of resistive RV afterload variance is reflected in serum NT-proBNP concentration in pediatric patients with PAH with no sign of left ventricular dysfunction. Reactive afterload appears to contribute to myocardial NT-proBNP release at advanced stages of PAH. Therefore, in mild-to-moderate PAH, resistive afterload is likely the greatest contributor to RV wall stress. These findings could also be used to estimate invasive RHC measurements from serum biochemical analysis, but more work is needed to improve correlations and overcome the issue of interventricular decoupling.

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

Abstract: Elevated baseline BNP level in MS patients was independently associated with CI and RVSWI. Plasma BNP levels were reduced after successful PMV, which was associated with the reduction of the LA pressure.

Cited by 10 publications

References 29 publications

Impact of left atrial compliance improvement on functional status after percutaneous mitral valvuloplasty

Impact of left atrial compliance improvement on functional status after percutaneous mitral valvuloplasty

Assessment of successful percutaneous mitral commissurotomy by MRproANP and sCD146

Assessment of N‐Terminal Prohormone B‐Type Natriuretic Peptide as a Measure of Vascular and Ventricular Function in Pediatric Pulmonary Arterial Hypertension

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