Key Points
- Identify the primary clinical determinants of brain natriuretic peptide (BNP) and evaluate its prognostic value for cardiac events in asymptomatic patients with degenerative mitral regurgitation.
- Assessed 135 consecutive asymptomatic patients (mean age 60±14 years, 56% men) with moderate-to-severe degenerative mitral regurgitation and preserved left ventricular function.
- Performed comprehensive transthoracic echocardiography with two-dimensional speckle tracking quantification (global longitudinal strain) and measured plasma BNP levels at baseline over a mean follow-up of 23±19 months.
- Indexed left atrium volume (p=0.008), mitral deceleration time (p=0.003), and global longitudinal strain (p<0.0001) were independently associated with BNP levels.
- Over follow-up, 54 cardiac events occurred with a 4-year event-free survival of 50±6%, demonstrating a graded decrease in survival across rising BNP quartiles (p<0.0001).
- Multivariable Cox analysis identified indexed left atrium volume (HR=1.04, p=0.003), global longitudinal strain (HR=1.14, p=0.007), and the 3rd (HR=8.5, p=0.002) and 4th quartiles of BNP (HR=8.8, p=0.002) as independent determinants of event-free survival.
Structured PICO
Does plasma BNP level predict cardiac events in asymptomatic patients with moderate to severe degenerative mitral regurgitation and preserved LV function?
PPopulation135 consecutive asymptomatic patients with moderate to severe degenerative mitral regurgitation and preserved left ventricular function, mean age 60±14 years, 56% men.
IInterventionMeasurement of plasma brain natriuretic peptide (BNP) and comprehensive transthoracic echocardiography including two-dimensional speckle tracking quantification (global longitudinal strain).
OOutcomeBNP level and cardiac eventshard clinical
In asymptomatic patients with degenerative mitral regurgitation, elevated BNP levels and reduced global longitudinal strain are powerful independent predictors of cardiac events, which may help improve risk stratification.