Advertisement

Association of B-Type Natriuretic Peptide Activation to Left Ventricular End-Systolic Remodeling in Organic and Functional Mitral Regurgitation

Published:February 27, 2006DOI:https://doi.org/10.1016/j.amjcard.2005.10.061
      B-type natriuretic peptide (BNP) is activated with mitral regurgitation (MR), but it is unclear whether BNP activation is uniform in organic and functional MR and whether it merely reflects symptoms or is a biomarker of left ventricular (LV) geometric and functional alterations. Comprehensive Doppler echocardiography and hormonal measurements were performed prospectively in 99 patients, 50 with organic MR, 28 with functional MR (with similar LV enlargement 130 ± 21 vs 141 ± 40, p = 0.18, and age 64 ± 13 vs 66 ± 12 years, p = 0.56) and 21 controls subjects of similar age. Compared with the controls, the patients with MR displayed LV remodeling and BNP activation. In those with functional MR compared with those with organic MR, despite a lower regurgitant volume (25 ± 25 vs 96 ± 29 ml), higher BNP levels were noted (385 ± 388 vs 70 ± 97 pg/ml, p <0.0001), even after stratification by functional class (class I 120 ± 122 vs 33 ± 40, class II 318 ± 470 vs 74 ± 69, class III to IV 487 ± 383 vs 268 ± 165 pg/ml, p = 0.006). The major determinant of BNP activation was the LV end-systolic volume index (p <0.0001), independent of MR etiology, symptoms, other hormonal activation, and hemodynamic characteristics. The BNP level is a biomarker of LV alteration in patients with MR, independent of MR etiology. With BNP >90 pg/ml, the odds ratio of an end-systolic volume index value of ≥60 ml/m2 was 16 (95% confidence interval 5.5 to 45). In conclusion, BNP activation with MR is more pronounced in those with functional than those with organic MR, even after stratification for functional class, and independently reflects the severity of the LV alteration. Pronounced BNP activation is linked to a higher end-systolic volume index, for which it is a biomarker, irrespective of MR etiology and symptoms.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Cardiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Levin E.R.
        • Gardner D.G.
        • Samson W.K.
        Natriuretic peptides.
        N Engl J Med. 1998; 339: 321-328
        • Omland T.
        • Persson A.
        • Ng L.
        • O’Brien R.
        • Karlsson T.
        • Herlitz J.
        • Hartford M.
        • Caidahl K.
        N-terminal pro-B-type natriuretic peptide and long-term mortality in acute coronary syndromes.
        Circulation. 2002; 106: 2913-2918
        • Cheng V.
        • Kazanagra R.
        • Garcia A.
        • Lenert L.
        • Krishnaswamy P.
        • Gardetto N.
        • Clopton P.
        • Maisel A.
        A rapid bedside test for B-type peptide predicts treatment outcomes in patients admitted for decompensated heart failure.
        J Am Coll Cardiol. 2001; 37: 386-391
        • Sutton T.M.
        • Stewart R.A.
        • Gerber I.L.
        • West T.M.
        • Richards A.M.
        • Yandle T.G.
        • Kerr A.J.
        Plasma natriuretic peptide levels increase with symptoms and severity of mitral regurgitation.
        J Am Coll Cardiol. 2003; 41: 2280-2287
        • Brookes C.I.
        • Kemp M.W.
        • Hooper J.
        • Oldershaw P.J.
        • Moat N.E.
        Plasma brain natriuretic peptide concentrations in patients with chronic mitral regurgitation.
        J Heart Valve Dis. 1997; 6: 608-612
        • Detaint D.
        • Messika-Zeitoun D.
        • Avierinos J.F.
        • Scott C.
        • Chen H.
        • Burnett Jr, J.C.
        • Enriquez-Sarano M.
        B-type natriuretic peptide in organic mitral regurgitation.
        Circulation. 2005; 111: 2391-2397
        • Enriquez-Sarano M.
        • Tajik A.
        • Schaff H.
        • Orszulak T.
        • Bailey K.
        • Frye R.
        Echocardiographic prediction of survival after surgical correction of organic mitral regurgitation.
        Circulation. 1994; 90: 830-837
        • Borow K.
        • Green L.
        • Mann T.
        • Sloss L.
        • Braunwald E.
        • Colins J.
        • Cohn L.
        • Grossman W.
        End systolic volume as a predictor of postoperative left ventricular performance in volume overload from valvular regurgitation.
        Am J Med. 1980; 68: 655-663
        • Schiller N.
        • Shah P.
        • Crawford M.
        • DeMaria A.
        • Devereux R.
        • Feigenbaum H.
        • Gutgesell H.
        • Reichek N.
        • Sahn D.
        • Schnittger I.
        • Tajik A.
        • American Society of Echocardiography Committee on Standards, Subcommittee on Quantitation of Two-Dimensional Echocardiograms
        Recommendations for quantitation of the left ventricle by two-dimensional echocardiography.
        J Am Soc Echocardiograph. 1989; 2: 358-367
        • Rozich J.
        • Carabello B.
        • Usher B.
        • Kratz J.
        • Bell A.
        • Zile M.
        Mitral valve replacement with and without chordal preservation in patients with chronic mitral regurgitation. Mechanisms for differences in postoperative ejection performance.
        Circulation. 1992; 86: 1718-1726
        • Carabello B.
        • Nolan S.
        • McGuire L.
        Assessment of preoperative left ventricular function in patients with mitral regurgitation.
        Circulation. 1981; 64: 1212-1217
        • Devereux R.B.
        • Alonso D.R.
        • Lutas E.M.
        • Gottlieb G.J.
        • Campo E.
        • Sachs I.
        • Reichek N.
        Echocardiographic assessment of left ventricular hypertrophy.
        Am J Cardiol. 1986; 57: 450-458
        • Enriquez-Sarano M.
        • Bailey K.
        • Seward J.
        • Tajik A.
        • Krohn M.
        • Mays J.
        Quantitative Doppler assessment of valvular regurgitation.
        Circulation. 1993; 87: 841-848
        • Enriquez-Sarano M.
        • Seward J.
        • Bailey K.
        • Tajik A.
        Effective regurgitant orifice area.
        J Am Coll Cardiol. 1994; 23: 443-451
        • Enriquez-Sarano M.
        • Freeman W.
        • Tribouilloy C.
        • Orszulak T.
        • Khandheria B.
        • Seward J.
        • Bailey K.
        • Tajik A.
        Functional anatomy of mitral regurgitation.
        J Am Coll Cardiol. 1999; 34: 1129-1136
        • Burnett Jr, J.C.
        • Kao P.C.
        • Hu D.C.
        • Heser D.W.
        • Heublein D.
        • Granger J.P.
        • Opgenorth T.J.
        • Reeder G.S.
        Atrial natriuretic peptide elevation in congestive heart failure in the human.
        Science. 1986; 231: 1145-1147
        • Yasue H.
        • Yoshimura M.
        • Sumida H.
        • Kikuta K.
        • Kugiyama K.
        • Jougasaki M.
        • Ogawa H.
        • Okumura K.
        • Mukoyama M.
        • Nakao K.
        Localization and mechanism of secretion of B-type natriuretic peptide in comparison with those of A-type natriuretic peptide in normal subjects and patients with heart failure.
        Circulation. 1994; 90: 195-203
        • Lerman A.
        • Edwards B.S.
        • Hallett J.W.
        • Heublein D.M.
        • Sandberg S.M.
        • Burnett Jr, J.C.
        Circulating and tissue endothelin immunoreactivity in advanced atherosclerosis.
        N Engl J Med. 1991; 325: 997-1001
        • Yamamoto K.
        • Burnett Jr, J.C.
        • Jougasaki M.
        • Nishimura R.A.
        • Bailey K.R.
        • Saito Y.
        • Nakao K.
        • Redfield M.M.
        Superiority of brain natriuretic peptide as a hormonal marker of ventricular systolic and diastolic dysfunction and ventricular hypertrophy.
        Hypertension. 1996; 28: 988-994
        • Crilley J.G.
        • Farrer M.
        Left ventricular remodelling and brain natriuretic peptide after first myocardial infarction.
        Heart. 2001; 86: 638-642
        • Nagaya N.
        • Nishikimi T.
        • Goto Y.
        • Miyao Y.
        • Kobayashi Y.
        • Morii I.
        • Daikoku S.
        • Matsumoto T.
        • Miyazaki S.
        • Matsuoka H.
        • et al.
        Plasma brain natriuretic peptide is a biochemical marker for the prediction of progressive ventricular remodeling after acute myocardial infarction.
        Am Heart J. 1998; 135: 21-28
        • Richards A.M.
        • Nicholls M.G.
        • Yandle T.G.
        • Frampton C.
        • Espiner E.A.
        • Turner J.G.
        • Buttimore R.C.
        • Lainchbury J.G.
        • Elliott J.M.
        • Ikram H.
        • Crozier I.G.
        • Smyth D.W.
        Plasma N-terminal pro-brain natriuretic peptide and adrenomedullin.
        Circulation. 1998; 97: 1921-1929
        • Tang W.H.
        • Girod J.P.
        • Lee M.J.
        • Starling R.C.
        • Young J.B.
        • Van Lente F.
        • Francis G.S.
        Plasma B-type natriuretic peptide levels in ambulatory patients with established chronic symptomatic systolic heart failure.
        Circulation. 2003; 108: 2964-2966
        • Dao Q.
        • Krishnaswamy P.
        • Kazanegra R.
        • Harrison A.
        • Amirnovin R.
        • Lenert L.
        • Clopton P.
        • Alberto J.
        • Hlavin P.
        • Maisel A.S.
        Utility of B-type natriuretic peptide in the diagnosis of congestive heart failure in an urgent-care setting.
        J Am Coll Cardiol. 2001; 37: 379-385
        • Yamaguchi H.
        • Yoshida J.
        • Yamamoto K.
        • Sakata Y.
        • Mano T.
        • Akehi N.
        • Hori M.
        • Lim Y.J.
        • Mishima M.
        • Masuyama T.
        Elevation of plasma brain natriuretic peptide is a hallmark of diastolic heart failure independent of ventricular hypertrophy.
        J Am Coll Cardiol. 2004; 43: 55-60
        • de Lemos J.A.
        • McGuire D.K.
        • Drazner M.H.
        B-type natriuretic peptide in cardiovascular disease.
        Lancet. 2003; 362: 316-322
        • Mayer S.A.
        • De Lemos J.A.
        • Murphy S.A.
        • Brooks S.
        • Roberts B.J.
        • Grayburn P.A.
        Comparison of B-type natriuretic peptide levels in patients with heart failure with versus without mitral regurgitation.
        Am J Cardiol. 2004; 93: 1002-1006
        • Wisenbaugh T.
        • Skudicky D.
        • Sareli P.
        Prediction of outcome after valve replacement for rheumatic mitral regurgitation in the era of chordal preservation.
        Circulation. 1994; 89: 191-197
        • Bonow R.
        • Carabello B.
        • DeLeon A.
        • Edmunds L.
        • Fedderly B.
        • Freed M.
        • Gaasch W.
        • McKay C.
        • Nishimura R.
        • O’Gara P.
        • O’Rourke R.
        • Rahimtoola S.
        ACC/AHA guidelines for the management of patients with valvular heart disease.
        Circulation. 1998; 98: 1949-1984
        • Enriquez-Sarano M.
        • Miller F.J.
        • Hayes S.
        • Bailey K.
        • Tajik A.
        • Seward J.
        Effective mitral regurgitant orifice area.
        J Am Coll Cardiol. 1995; 25: 703-709
        • Grigioni F.
        • Enriquez-Sarano M.
        • Zehr K.
        • Bailey K.
        • Tajik A.
        Ischemic mitral regurgitation.
        Circulation. 2001; 103: 1759-1764