Plasma brain natriuretic peptide concentrations in patients with valvular heart disease

Vishal Sharma, Ralph A Stewart, Mildred Lee, Ruvin Gabriel, Niels Van Pelt, David E Newby, Andrew J Kerr

Research output: Contribution to journalArticlepeer-review

Abstract

OBJECTIVE: Plasma brain natriuretic peptide (BNP) concentrations predict prognosis in patients with valvular heart disease (VHD), but it is unclear whether this directly relates to disease severity. We assessed the relationship between BNP and echocardiographic measures of disease severity in patients with VHD.

METHODS: Plasma BNP concentrations were measured in patients with normal left ventricular (LV) systolic function and isolated VHD (mitral regurgitation (MR), n=33; aortic regurgitation (AR), n=39; aortic stenosis (AS), n=34; mitral stenosis (MS), n=30), and age-matched and sex-matched controls (n=39) immediately prior to exercise stress echocardiography.

RESULTS: Compared with controls, patients with VHD had elevated plasma BNP concentrations (MR median 35 (IQR 23-52), AR 34 (22-45), AS 31 (22-60), MS 58 (34-90); controls 24 (16-33) pg/mL; p<0.01 for all). LV end diastolic volume index varied by valve lesion; (MR (mean 77±14), AR (91±28), AS (50±17), MS (43±11), controls (52±13) mL/m(2); p<0.0001). There were no associations between LV volume and BNP. Left atrial (LA) area index varied (MR (18±4 cm(2)/m(2)), AR (12±2), AS (11±3), MS (19±6), controls (11±2); p<0.0001), but correlated with plasma BNP concentrations: MR (r=0.42, p=0.02), MS (r=0.86, p<0.0001), AR (r=0.53, p=0.001), AS (r=0.52, p=0.002). Higher plasma BNP concentrations were associated with increased pulmonary artery pressure and reduced exercise capacity. Despite adverse cardiac remodelling, 81 (60%) patients had a BNP concentration within the normal range.

CONCLUSIONS: Despite LV remodelling, plasma BNP concentrations are often normal in patients with VHD. Conversely, mild elevations of BNP occur with LA dilatation in the presence of normal LV. Plasma BNP concentrations should be interpreted with caution when assessing patients with VHD.

Original languageEnglish
Pages (from-to)e000184
JournalOpen heart
Volume3
Issue number1
DOIs
Publication statusPublished - 4 May 2016

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