Cio. Brookes et al., PLASMA BRAIN NATRIURETIC PEPTIDE CONCENTRATIONS IN PATIENTS WITH CHRONIC MITRAL REGURGITATION, Journal of heart valve disease, 6(6), 1997, pp. 608-612
Background and aims of the study: Patients with chronic mitral regurgi
tation (MR) are often referred for surgery only after irreversible lef
t ventricular (LV) dysfunction has developed. Our aim was to determine
whether plasma brain natriuretic peptide (BNP) concentrations could s
erve as a marker for early LV dysfunction in this condition. Methods:
Twenty-two patients with isolated chronic MR and echocardiographic evi
dence of at least moderate regurgitation were studied. Results: Plasma
BNP concentrations were significantly higher in patients than in norm
al volunteers (20.85 +/- 16.9 versus 3.37 +/- 0.9 pmol/l; p = 0.007).
Concentrations increased with increasing severity of symptoms and were
highest in those in NYHA class IV, but did not correlate with LV dime
nsions, fractional shortening or left atrial size. Of note, two asympt
omatic patients with high BNP concentrations were referred for surgery
within the 12-month follow up period due to symptom progression. Conc
lusions: Plasma BNP concentrations are elevated in most patients with
isolated chronic MR, including those who are asymptomatic with normal
LV dimensions. The significance of these findings is uncertain, but th
ey suggest that changes in ventricular physiology occur early in the d
isease process and before they can be detected echocardiographically.
Longitudinal studies are required to determine if patients with high B
NP levels have an adverse prognosis and if this can be altered by earl
ier surgical intervention.