B-type Natriuretic Peptide as an Index of Symptoms and Severity of Chronic Rheumatic Mitral Regurgitation
Eman M Abdel Fattah1, Hany Younan Azer Girgis1, Khaled El Khashab1
1Department of Cardiology, Fayoum University, Egypt.
Background:
The most common causes of severe mitral regurgitation (MR) in developing countries are rheumatic heart disease. The plasma level of B-type natriuretic peptide (BNP) is known to increase with left ventricular (LV) dysfunction.
Aim Of The Work:
To study BNP level as an index of symptoms and severity of chronic rheumatic MR.
Patients And Methods:
One hundred and forty patients with rheumatic MR and LV ejection fractions (EFs) of >55% underwent assessment of symptoms, transthoracic echocardiography, and measurement of BNP.
Results:
The level of BNP rose with increasing left atrium (LA) dimensions and volumes, LV dimensions and volumes, echocardiographic parameters of MR severity (width of the vena contracta, regurgitation jet area, effective regurgitation orifice area, and regurgitant volume), and E waves.
Results:
BNP was significantly higher in patients with severe MR compared with moderate and mild MR (P < 0.001), and using cutoff point of 61 pg/mL mm had 97% sensitivity and 89% specificity for predicting patients with severe MR (0.99, 95% confidence interval [CI] 0.9-1). BNP was significantly higher in patients with New York Heart Association (NYHA III) compared with NYHA II, I and asymptomatic patients (P < 0.001) and using cutoff point of 53 pg/mL had 97% sensitivity and 87% specificity for predicting symptomatic patients with symptomatic MR (0.81, 95% CI 0.70-0.92).
Conclusions:
BNP level increase with increasing severity of rheumatic MR and are higher in symptomatic compared to asymptomatic patients, even in the presence of normal EF%.
Insights
B-type natriuretic peptide (BNP) levels correlate with the severity of rheumatic mitral regurgitation (MR) and symptoms, even with normal ejection fraction. BNP effectively predicts severe MR and symptomatic patients.
Area of Science:
- Cardiology
- Biomarkers
- Valvular Heart Disease
Background:
- Rheumatic heart disease is a primary cause of severe mitral regurgitation (MR) in developing nations.
- Elevated B-type natriuretic peptide (BNP) levels are associated with left ventricular (LV) dysfunction.
Purpose of the Study:
- To evaluate B-type natriuretic peptide (BNP) levels as an indicator of symptom severity in chronic rheumatic mitral regurgitation (MR).
Main Methods:
- Assessed 140 patients with rheumatic MR and preserved LV ejection fraction (>55%).
- Evaluated symptoms, performed transthoracic echocardiography, and measured plasma BNP levels.
Main Results:
- BNP levels increased with left atrial and ventricular dimensions, MR severity parameters (vena contracta, jet area, orifice area, regurgitant volume), and E waves.
- Significantly higher BNP in severe MR vs. moderate/mild MR (97% sensitivity, 89% specificity at 61 pg/mL).
- Significantly higher BNP in symptomatic (NYHA III) vs. asymptomatic patients (97% sensitivity, 87% specificity at 53 pg/mL).
Conclusions:
- BNP levels rise with increasing rheumatic MR severity.
- BNP is elevated in symptomatic patients compared to asymptomatic individuals, irrespective of normal ejection fraction.
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