Results of surgical treatment of valvular heart diseases with theevaluation of brain natriuretic peptide levels in short-term andlong-term follow-up

Authors: T.G. Nikitina, K.S. Gulyan, I.B. Nezhdanova, N.N. Samsonova, M.G. Plyushch, L.A. Bockeria

Company: A.N. Bakoulev Scientific Center for Cardiovascular Surgery; Rublevskoe shosse, 135, Moscow, 121552, Russian Federation


DOI: https://doi.org/10.15275/kreatkard.2015.02.03

For citation: T.G. Nikitina, K.S. Gulyan, I.B. NezhdanovaResults of surgical treatment of valvular heart diseases with the evaluation of brain natriuretic peptide levels in short-term and long-term follow-up 2015; 2: 30-37

Keywords: brain natriuretic peptide valvular heart diseases heart failure

Download
Full text:  

 

Abstract

Purpose. To evaluate prognostic value of preoperative brain natriuretic peptide (BNP) level in patients with valvular heart diseases at early postoperative period and in long-term follow-up. Material and methods. We enrolled 54 patients with valvular heart diseases: mitral valve diseases – 37%, aortic valve diseases – 31.5 % and bivalvular heart diseases 31.5 %. The average follow-up period was 12.9±5.9 months. Thirty six (66.7%) patients underwent isolated or combined operations for valvular disease, while 18 (33.3%) patients stayed on medical treatment due to high surgical risk.

Results. Mean BNP level at admission was 577.8±668.93 pg/ml, and was significantly higher on 2–3 day after surgery – 918.8±625.74 pg/ml (р=0.029), but on 10–14 postoperative day BNP level became significantly lower comparably to preoperative level – 410.64±263.9 pg/ml (р=0.01) and in 6–12 months after surgery it was 280.4±193.4 pg/ml (р=0.014). According to ROC-analysis preoperative BNP level over 486.2 pg/ml predicted postoperative cardiac complications: acute heart failure (AHF) and ventricular arrhythmias (VA) (AUC 0.634, 95% confidence interval (CI) 0.5–0.78, р=0.0014; AUC 0.789, 95% CI 0.56–1.0, р=0.044 respectively). Preoperative BNP over 607.76 pg/ml predicted atrial fibrillation at the early postoperative period (AUC 0.732, 95% CI 0.56–0.91, р=0.039) and heart failure in 6–12 months after surgery (AUC 0.737, 95% CI 0.58–0.89, р=0.022). BNP level over 1120.68 pg/ml at admission had significant predictive value on all-cause mortality (both in patients underwent surgical treatment or not) (AUC 0.8, 95% CI 0.64–1.0, р=0.015).

Conclusion. High preoperative BNP level significantly predicts postoperative cardiac complications in patients with valvular heart diseases early after surgical treatment and in long-term follow-up period. Analysis revealed that plasma level of BNP rise immediately after operation (2–3 days), and lowered at 10–14 days after cardiac surgery and from 6 to 12 months after the operation.

References

1. Mair J., Friedl W., Thomas S., Puschendorf B. Natriuretic peptides in assessment of leftventricular dysfunction. Scand. J. Clin. Lab. Invest. Suppl. 1999; 230: 132–42. 2. Neverdal N.O., Knudsen C.W., Husebye T., Vengen O.A., Pepper J., Lie M., Tønnessen T. The effect of aortic valve replacement on plasma B-type natriuretic peptide in patients with severe aortic stenosis – one year follow-up. Eur. J. Heart Fail. 2006; 8 (3): 257–62. 3. Алиева А.М., Стародубова А.В., Пинчук Т.В. Ди- агностические возможности предшественни- ков натрийуретических пептидов у больных с хронической сердечной недостаточностью ишемической этиологии. Лечебное дело. 2014; 3: 32–9. 4. Georges А., Forestier F., Valli N., Plogin A., Janvier G., Bordenave L. Changes in type B natriuretic peptide (BNP) concentrations during cardiac valve replacement. Eur. J. Cardiothorac. Surg. 2004; 25 (6): 941–5. 5. Moazami N., Oz M.C. Natriuretic peptides in the perioperative management of cardiac surgery patients. Heart. Surg. Forum. 2005; 8 (3): 151–7. 6. Sinha A.M., Breithardt O.A., Schmid M., Stellbrink C. Brain natriuretic peptide release in cardiac surgery patients. Thorac. Cardiovasc. Surg. 2005; 53 (3): 138–43. 7. Attaran S., Sherwood R., Desai J., Langworthy R., Mhandu P., John .L, El-Gamel A. Brain natriuretic peptide a predictive marker in cardiac surgery. Interact. Cardiovasc. Thorac. Surg. 2009; 9 (4): 662–6. 8. Wazni O.M., Martin D.O., Marrouche N.F., Latif A.A., Ziada K., Shaaraoui M. et al. Plasma Btype natriuretic peptide levels predict postoperative atrial fibrillation in patients undergoing cardiac surgery. Circulation. 2004; 110: 124–7. 9. Бокерия Л.А., Иванова З.З. Оценка морфофунк- циональных особенностей левого предсердия у пациентов с фибрилляцией предсердий с по- мощью компьютерной и магнитно-резонанс- ной томографии. Анналы аритмологии. 2014; 11 (4): 213–21. DOI: 10.15275/annaritmol.2014.4.4. 10. Hwang I.C., Kim Y.J., Kim K.H., Lee S.P., Kim H.K., Sohn D.W., Oh B.H., Park Y.B. Prognostic value of B-type natriuretic peptide in patients with chronic mitral regurgitation undergoing surgery: mid-term follow-up results. Eur. J. Cardiothorac. Surg. 2013; 43 (1): e1–6. 11. Klaar U., Gabriel H., Bergler-Klein J., Pernicka E., Heger M., Mascherbauer J., Rosenhek R., Binder T., Maurer G., Baumgartner H. Prognostic value of serial B-type natriuretic peptide measurement in asymptomatic organic mitral regurgitation. Eur J. Heart Fail. 2011; 13 (2): 163–9. 12. Бокерия Л.А., Самуилова Д.Ш., Плющ М.Г. Моз- говой натрийуретический пептид – современ- ный маркер сердечной недостаточности. Кли- ническое значение. Грудная и сердечно-сосудис- тая хирургия. 2007; 4: 61–6. 13. Chelloa M., Mastrorobertoa P., Perticoneb F., Cirilloa F., Bevacquaa E., Olivitoa S., Covinoa E. Plasma levels of atrial and brain natriuretic peptides as indicators of recovery of left ventricular systolic function after coronary artery bypass. Eur. J. Cardiothorac. Surg. 2001; 20 (1): 140–6. 14. Detaint D., Messika-Zeitoun D., Avierinos J.F., Scott C., Chen H., Burnett J.C., Jr., EnriquezSarano M. B-type brain natriuretic peptide in organic mitral regurgitation: determinants and impact on outcome. Circulation. 2005; 111 (18): 2391–7. 15. Lim P., Monin J.L., Monchi M., Garot J., Pasquet A., Hittinger L., Vanoverschelde J.L., Carayon A., Gueret P. Predictors of outcome in patients with severe aortic stenosis and normal left ventricular function: role of B-type natriuretic peptide. Eur. Heart J. 2004; 25 (22): 2048–53. 16. Maisel A.S., Krishnaswamy P., Nowak R.M., McCord J., Hollander J.E., Duc P., Omland T., Storrow A.B., Abraham W.T., Wu A.H., Clopton P., Steg P.G., Westheim A., Knudsen C.W., Perez A., Kazanegra R., Herrmann H.C., McCullough P.A. Rapid measurement of B-type natriuretic peptide in the emergency diagnosis of heart failure. N. Engl. J. Med. 2002; 347: 161–7. 17. Mukoyama M., Nakao K., Hosoda K., Suga S., Saito Y., Ogawa Y., Shirakami G., Jougasaki M., Obata K., Yasue H. et al. Brain natriuretic peptide as a novel cardiac hormone in humans: evidence for an exquisite dual natriuretic peptide system? J. Clin. Invest. 1991; 87 (4): 1402–12. 18. Fox A.A., Shernan S.K., Collard C.D., Liu K.Y., Aranki S.F., DeSantis S.M., Jarolim P., Body S.C. Preoperative B-type natriuretic peptide is as independent predictor of ventricular dysfunction and mortality after primary coronary artery bypass grafting. J. Thorac. Cardiovasc. Surg. 2008; 136 (2): 452–61. 19. Hutfless R., Kazanegra R., Madani M., Bhalla M.A., Tulua-Tata A., Chen A., Clopton P., James C., Chiu A., Maisel A.S. Utility of B-type natriuretic peptide (BNP) in predicting postoperative complications and outcomes in patients undergoing heart surgery. J. Am. Coll. Cardiol. 2004; 43 (10): 1873–9. 20. Sartipy U., Alba°ge A., Larsson P.T., Insulander P., Lindblom D. Changes in B-type natriuretic peptides after surgical ventricular restoration. Eur. J. Cardiothorac. Surg. 2007; 31: 922–8. 21. Pablo C., María P., Varela O., Margarita P., Mirta D. Utilidad del péptido natriurético cerebral para predecir complicaciones en el postoperatorio de cirugía cardiac. Rev. CONAREC. 2006; 87 (22): 255–8. 22. Berendes E., Schmidt C., Van Aken H., Hartlage M.G., Rothenburger M., Wirtz S., Scheld H.H., Brodner G., Walter M. A-type and Btype natriuretic peptides in cardiac surgical procedures. Anesth. Analg. 2004; 98. (1): 11–9. 23. Bergler-Klein J., Klaar U., Heger M. et al. Natriuretic peptides predict symptom-free survival and postoperative outcome in severe aortic stenosis. Circulation. 2004; 109: 2302–8. 24. Cheng V., Kazanagra R., Garcia A., Lenert L., Krishnaswamy P., Gardetto N., Clopton P., Maisel A. A rapid bedside test for B-type peptide predicts treatment outcomes in patients admitted for decompensated heart failure: a pilot study. J. Am. Coll. Cardiol. 2001; 37: 386–91. 25. Bettencourt P., Ferreira S., Azevedo A., Ferreira A. Preliminary data on the potential usefulness of B-type natriuretic peptide levels in predicting outcome after hospital discharge in patients with heart failure. Am. J. Med. 2002; 113 (3): 215–9. 26. Watanabe M., Murakami М., Furukawa H., Nakahara H. Is measurement of plasma brain natriuretic peptide levels a useful test to detect for surgical timing of valve disease? Int. J. Cardiol. 2004; 96: 21–4.

Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, President of Bakoulev National Medical Research Center for Cardiovascular Surgery