Edinburgh Research Explorer

Plasma brain natriuretic peptide concentrations in patients with valvular heart disease

Research output: Contribution to journalArticle

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

Related Edinburgh Organisations

Open Access permissions



  • Download as Adobe PDF

    Rights statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial.

    Final published version, 578 KB, PDF document

    Licence: Creative Commons: Attribution Non-Commercial (CC-BY-NC)

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


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.

Download statistics

No data available

ID: 26696068