Key result
Surgical ventricular restoration significantly reduced NT-pro-BNP levels from 2406 pg/ml at baseline to 1510 pg/ml at 6 months (p=0.03) and 975 pg/ml at late follow-up (p=0.03).
Why the study?
Does surgical ventricular restoration improve natriuretic peptide levels and functional status in patients with post-infarction left ventricular aneurysm and depressed left ventricular function?
Cohort (n=29)
No
Does surgical ventricular restoration improve natriuretic peptide levels and functional status in patients with post-infarction left ventricular aneurysm and depressed left ventricular function?
p-value: p=0.03
Surgical ventricular restoration in patients with post-infarction left ventricular aneurysm is associated with significant improvements in functional status, ejection fraction, and reductions in natriuretic peptide levels.
SVR was associated with sustained NT-proBNP reduction; leaves open whether this improves outcomes in post-MI LV aneurysm.
OBJECTIVE: The aim of this study was to prospectively investigate changes in brain natriuretic peptide (BNP) and amino terminal pro-BNP (NT-pro-BNP) in relation to functional status after surgical ventricular restoration (SVR). METHODS: Between March 2003 and May 2006, 29 patients (20 men and 9 women, mean age 65 years, mean ejection fraction 24%) with post-infarction left ventricular aneurysm and depressed left ventricular function underwent SVR according to the Dor technique at our institution. Twenty-two patients (76%) were in New York heart association (NYHA) functional class III or IV. Multi-vessel disease was present in 26 patients. Natriuretic peptides, functional status, ejection fraction and left ventricular volumes were analyzed at baseline, after 6 months, and late postoperatively. RESULTS: There was no early mortality. Survival at 24 months was 93%. Six months postoperatively 25/29 (86%) patients were in NYHA class I and II (p<0.001) and at late (mean 21 months) follow-up, all patients were in NYHA class I and II. There was a persistent reduction of NT-pro-BNP (2406 pg/ml vs 1510 pg/ml; p=0.03 and 975 pg/ml; p=0.03) and BNP (312 pg/ml vs 228 pg/ml; p=0.12 and 191 pg/ml; p=0.20) 6 months postoperatively and at late follow-up, respectively. Ejection fraction improved from 24% to 37% (p<0.001) at 6 months. End-diastolic (110 ml/m(2) vs 90 ml/m(2), p=0.009) and end-systolic (75 ml/m(2) vs 52 ml/m(2), p=0.006) volume index were reduced at 6 months. Functional improvement correlated significantly with reduction in BNP (r=0.61, p=0.01) and NT-pro-BNP (r=0.58, p=0.003) 6 months after surgery. Ejection fraction correlated inversely with BNP (r=-0.58, p=0.02) and NT-pro-BNP (r=-0.51, p=0.04), and end-systolic volume correlated with BNP (r=0.65, p=0.03) and NT-pro-BNP (r=0.62, p=0.03) 6 months after surgery. CONCLUSIONS: Heart failure secondary to post-infarction left ventricular remodeling can be reversed by SVR. Improvement in these patients was associated with reduced levels of B-type natriuretic peptides 6 months after surgery. Clinical improvement was maintained and peptide levels were further reduced at late follow-up.
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Sartipy et al. (2007) conducted a cohort in post-infarction left ventricular aneurysm and depressed left ventricular function (n=29). Surgical ventricular restoration vs. Baseline was evaluated on Changes in brain natriuretic peptide (BNP) and amino terminal pro-BNP (NT-pro-BNP) (p=0.03). Surgical ventricular restoration significantly reduced NT-pro-BNP levels from 2406 pg/ml at baseline to 1510 pg/ml at 6 months (p=0.03) and 975 pg/ml at late follow-up (p=0.03).
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