Key result
Percutaneous mitral valvuloplasty significantly reduced plasma BNP levels from 124 to 73 pg/ml, and this reduction was independently associated with decreased left atrial pressure.
Why the study?
Does percutaneous mitral valvuloplasty reduce BNP levels and improve right ventricular stroke work in patients with symptomatic rheumatic mitral stenosis?
Observational (n=30)
Does percutaneous mitral valvuloplasty reduce BNP levels and improve right ventricular stroke work in patients with symptomatic rheumatic mitral stenosis?
Absolute Event Rate: 73% vs 124%
Successful percutaneous mitral valvuloplasty reduces BNP levels, which correlates with reductions in left atrial pressure and improvements in right ventricular stroke work.
BNP reduction after percutaneous mitral valvuloplasty was associated with left atrial pressure relief in mitral stenosis; hypothesis-generating, prospective trials needed before clinical adoption.
OBJECTIVES: We aimed to explore the relationship between brain natriuretic peptide (BNP) levels and right ventricular (RV) function in patients with mitral stenosis (MS), and to investigate the hemodynamic parameters that predict reduction of BNP levels after percutaneous mitral valvuloplasty (PMV). BACKGROUND: Few studies have evaluated BNP in the context of MS, specifically the impact of the RV stroke work (RVSW) on serum BNP levels has not been defined. METHODS: Thirty patients with symptomatic rheumatic MS in sinus rhythm who were referred for a PMV were enrolled. Right and left heart pressures were obtained before and after valvuloplasty. RVSW index (RVSWI) was calculated by cardiac catheterization. RESULTS: Basal BNP levels were elevated in MS patients and correlated with several hemodynamic parameters including pulmonary pressure, pulmonary vascular resistance index, cardiac index (CI), and RVSWI. In multivariate analysis, CI and RVSWI were independent predictors of raised basal BNP levels. PMV resulted in a significant decrease in the RVSWI with a concurrent increase in CI (2.4 ± 0.43 to 2.9 ± 0.8 L/min/m(2), P = 0.010). Overall, plasma BNP levels significantly decreased from 124 (63/234) to 73 (48/148) pg/ml postvalvuloplasty. Multivariate analysis revealed that the reduction of left atrial (LA) pressure post-PMV was an independent predictor of change in BNP levels. CONCLUSIONS: 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.
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Esteves et al. (2013) conducted an observational in Mitral stenosis (n=30). Percutaneous mitral valvuloplasty vs. Baseline (pre-valvuloplasty) was evaluated on Plasma BNP levels (pg/ml). Percutaneous mitral valvuloplasty significantly reduced plasma BNP levels from 124 to 73 pg/ml, and this reduction was independently associated with decreased left atrial pressure.
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