Clinical Research
Valvular Heart Disease
Prospective Validation of the Prognostic Usefulness of Brain Natriuretic Peptide in Asymptomatic Patients With Chronic Severe Mitral Regurgitation

https://doi.org/10.1016/j.jacc.2009.06.013Get rights and content
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Objectives

The purpose of the study was to determine the independent and additive prognostic value of brain natriuretic peptide (BNP) in patients with severe asymptomatic mitral regurgitation and normal left ventricular function.

Background

Early surgery could be advisable in selected patients with chronic severe mitral regurgitation, but there are no criteria to identify candidates who could benefit from this strategy. Assessment of BNP has not been studied in asymptomatic patients with severe mitral regurgitation; hence, its prognostic value remains unclear.

Methods

We prospectively evaluated 269 consecutive patients with severe asymptomatic organic mitral regurgitation and left ventricular ejection fraction above 60%. The first 167 consecutive patients served as the derivation cohort, and the following 102 patients served as a validation cohort. The combined end point was the occurrence of either symptoms of congestive heart failure, left ventricular dysfunction, or death at follow-up.

Results

The end point was reached in 35 (21%) patients of the derivation set and in 21 (20.6%) patients of the validation cohort. The receiver-operating characteristics curve yielded an optimal cutoff point of 105 pg/ml of BNP that was able to discriminate patients at higher risk in both cohorts (76% vs. 5.4% and 66% vs. 4.0%, respectively). In both sets, BNP was the strongest independent predictor by multivariate analysis.

Conclusions

Among patients with severe asymptomatic organic mitral regurgitation, BNP ≥105 pg/ml discriminates a subgroup of patients at higher risk. Because of its incremental prognostic value, BNP assessment should be considered in clinical routine workup for risk stratification.

Key Words

mitral regurgitation
natriuretic peptide
prognosis

Abbreviations and Acronyms

AV
atrial volume
BNP
brain natriuretic peptide
BSA
body surface area
CHF
congestive heart failure
CI
confidence interval
EROA
effective regurgitant orifice area
HR
hazard ratio
LVDSD
left ventricular dysfunction, symptoms of congestive heart failure, or death
NFL
new flail leaflet
NYHA
New York Heart Association
OR
odds ratio
ROC
receiver-operating characteristic

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