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

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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.

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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