Journal of Cardiovascular Imaging

Korean Society of Echocardiography (한국심초음파학회)
권호 표지
DOI QR코드

DOI QR Code

B-Type Natriuretic Peptide in Isolated Severe Tricuspid Regurgitation: Determinants and Impact on Outcome

  • Yoon, Chang-Hwan (Cardiovascular Center, Seoul National University Bundang Hospital) ;
  • Zo, Joo-Hee (Cardiovascular Center, Seoul National University Boramae Hospital) ;
  • Kim, Yong-Jin (Cardiovascular Center, Seoul National University Hospital) ;
  • Kim, Hyung-Kwan (Cardiovascular Center, Seoul National University Hospital) ;
  • Shine, Dong-Ho (Cardiovascular Center, Seoul National University Hospital) ;
  • Kim, Kyung-Hwan (Cardiovascular Center, Seoul National University Hospital) ;
  • Kim, Ki-Bong (Cardiovascular Center, Seoul National University Hospital) ;
  • Ahn, Hyuk (Cardiovascular Center, Seoul National University Hospital) ;
  • Sohn, Dae-Won (Cardiovascular Center, Seoul National University Hospital) ;
  • Oh, Byung-Hee (Cardiovascular Center, Seoul National University Hospital) ;
  • Park, Young-Bae (Cardiovascular Center, Seoul National University Hospital)
  • Published : 2010.12.27
⟨ Previous Next ⟩

Abstract

Background: The plasma B-type natriuretic peptide (BNP) level is a useful prognostic marker in heart failure and valvular heart disease. In patients with isolated severe tricuspid regurgitation (TR), little is known about the determinants of plasma BNP levels and the correlation with future outcome. The purpose of this study was to identify the determinants of plasma BNP levels in patients with isolated severe TR and the value of the BNP level in predicting postoperative outcomes after corrective surgery. Methods:We prospectively enrolled 39 patients with isolated, severe TR undergoing corrective surgery. A plasma BNP assay and cardiac magnetic resonance (CMR) imaging were performed before surgery. The combined end-point was the occurrence of cardiac death or readmission due to heart failure. Results: Linear regression analysis showed that the left ventricular ejection fraction and right ventricular end systolic volume were the most important determinants of the BNP levels (p = 0.002, $R^2$ = 0.315). Based on the receiver operating characteristics (ROC) curve, we were able to derive an optimal cutoff value (200 pg/mL) to predict postoperative cardiac death with a sensitivity of 80% and a specificity of 85%. The one-year survival rate was 96% in patients with a BNP < 200 pg/mL and 53% in patients with a BNP ${\geq}$ 200 pg/dL (p = 0.001). Conclusion: An elevation in the BNP level is determined by the functional status of the right and left ventricles in patients with isolated, severe TR. An elevated BNP predicts adverse events after corrective surgery. Therefore, the BNP level should be included in the clinical evaluation and risk stratification of patients with isolated TR.

Keywords

References

  1. Chaux A, Matloff JM. Tricuspid valve repair. Operative and follow-up evaluation by Doppler color flow mapping. J Thorac Cardiovasc Surg 1989;98:101-10; discussion 110-1
  2. Kim HK, Kim YJ, Kim KI, Jo SH, Kim KB, Ahn H, Sohn DW, Oh BH, Lee MM, Park YB, Choi YS. Impact of the maze operation combined with left-sided valve surgery on the change in tricuspid regurgitation over time. Circulation 2005;112:I14-9.
  3. Kim HK, Kim YJ, Park EA, Bae JS, Lee W, Kim KH, Kim KB, Sohn DW, Ahn H, Park JH, Park YB. Assessment of haemodynamic effects of surgical correction for severe functional tricuspid regurgitation: cardiac magnetic resonance imaging study. Eur Heart J 2010;31:1520-8. https://doi.org/10.1093/eurheartj/ehq063
  4. Kim YJ, Kwon DA, Kim HK, Park JS, Hahn S, Kim KH, Kim KB, Sohn DW, Ahn H, Oh BH, Park YB. Determinants of surgical outcome in patients with isolated tricuspid regurgitation. Circulation 2009;120: 1672-8. https://doi.org/10.1161/CIRCULATIONAHA.109.849448
  5. Kuwaki K, Morishita K, Tsukamoto M, Abe T. Tricuspid valve surgery for functional tricuspid valve regurgitation associated with left-sided valvular disease. Eur J Cardiothorac Surg 2001;20:577-82. https://doi.org/10.1016/S1010-7940(01)00786-2
  6. Kwon DA, Park JS, Chang HJ, Kim YJ, Sohn DW, Kim KB, Ahn H, Oh BH, Park YB, Choi YS. Prediction of outcome in patients undergoing surgery for severe tricuspid regurgitation following mitral valve surgery and role of tricuspid annular systolic velocity. Am J Cardiol 2006;98:659-61. https://doi.org/10.1016/j.amjcard.2006.03.047
  7. Staab ME, Nishimura RA, Dearani JA. Isolated tricuspid valve surgery for severe tricuspid regurgitation following prior left heart valve surgery: analysis of outcome in 34 patients. J Heart Valve Dis 1999;8:567-74.
  8. Kim HK, Kim YJ, Park JS, Kim KH, Kim KB, Ahn H, Sohn DW, Oh BH, Park YB, Choi YS. Determinants of the severity of functional tricuspid regurgitation. Am J Cardiol 2006;98:236-42. https://doi.org/10.1016/j.amjcard.2006.01.082
  9. 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, atrial natriuretic peptide and brain natriuretic peptide. J Clin Invest 1991;87:1402-12. https://doi.org/10.1172/JCI115146
  10. Nakagawa M, Tanaka I, Suga S, Ogawa Y, Tamura N, Goto M, Sugawara A, Yoshimasa T, Itoh H, Mukoyama M, et al. Preparation of a monoclonal antibody against mouse brain natriuretic peptide (BNP) and tissue distribution of BNP in mice. Clin Exp Pharmacol Physiol Suppl 1995;22:S186-7. https://doi.org/10.1111/j.1440-1681.1995.tb02874.x
  11. Ikeda K, Asahara T, Achiwa K, Hoshino H. Synthesis of N-acetylglucosaminyl- and N-acetylgalactosaminylceramides as cerebroside analogs and their anti-human immunodeficiency virus type 1 activities. Chem Pharm Bull (Tokyo) 1997;45:402-5. https://doi.org/10.1248/cpb.45.402
  12. Rademaker MT, Charles CJ, Espiner EA, Nicholls MG, Richards AM, Kosoglou T. Combined neutral endopeptidase and angiotensin-converting enzyme inhibition in heart failure: role of natriuretic peptides and angiotensin II. J Cardiovasc Pharmacol 1998;31:116-25. https://doi.org/10.1097/00005344-199801000-00017
  13. Isnard R. NT-BNP/BNP for screening left ventricular hypertrophy in hypertension: what else? Arch Cardiovasc Dis 2008;101:295-7. https://doi.org/10.1016/j.acvd.2008.05.004
  14. Detaint D, Messika-Zeitoun D, Avierinos JF, Scott C, Chen H, Burnett JC Jr, Enriquez-Sarano M. B-type natriuretic peptide in organic mitral regurgitation: determinants and impact on outcome. Circulation 2005;111:2391-7. https://doi.org/10.1161/01.CIR.0000164269.80908.9D
  15. Pizarro R, Bazzino OO, Oberti PF, Falconi M, Achilli F, Arias A, Krauss JG, Cagide AM. Prospective validation of the prognostic usefulness of brain natriuretic peptide in asymptomatic patients with chronic severe mitral regurgitation. J Am Coll Cardiol 2009;54:1099-106. https://doi.org/10.1016/j.jacc.2009.06.013
  16. Groves PH, Lewis NP, Ikram S, Maire R, Hall RJ. Reduced exercise capacity in patients with tricuspid regurgitation after successful mitral valve replacement for rheumatic mitral valve disease. Br Heart J 1991;66:295- 301. https://doi.org/10.1136/hrt.66.4.295
  17. Nath J, Foster E, Heidenreich PA. Impact of tricuspid regurgitation on long-term survival. J Am Coll Cardiol 2004;43:405-9. https://doi.org/10.1016/j.jacc.2003.09.036
  18. Vogelsang TW, Jensen RJ, Monrad AL, Russ K, Olesen UH, Hesse B, Kjaer A. Independent effects of both right and left ventricular function on plasma brain natriuretic peptide. Eur J Heart Fail 2007;9:892-6. https://doi.org/10.1016/j.ejheart.2007.05.015
  19. Grothues F, Moon JC, Bellenger NG, Smith GS, Klein HU, Pennell DJ. Interstudy reproducibility of right ventricular volumes, function, and mass with cardiovascular magnetic resonance. Am Heart J 2004;147:218- 23. https://doi.org/10.1016/j.ahj.2003.10.005
  20. Koskenvuo JW, Järvinen V, Parkka JP, Kiviniemi TO, Hartiala JJ. Cardiac magnetic resonance imaging in valvular heart disease. Clin Physiol Funct Imaging 2009;29:229-40. https://doi.org/10.1111/j.1475-097X.2009.00865.x

Cited by

  1. The Growing Clinical Importance of Secondary Tricuspid Regurgitation vol.59, pp.8, 2010, https://doi.org/10.1016/j.jacc.2011.09.069
  2. Prognostic value of B-type natriuretic peptide in patients with chronic mitral regurgitation undergoing surgery: mid-term follow-up results vol.43, pp.1, 2010, https://doi.org/10.1093/ejcts/ezs513
  3. Serum biomarkers in valvular heart disease vol.104, pp.4, 2010, https://doi.org/10.1136/heartjnl-2016-310482
  4. Tricuspid valve disease: diagnosis, prognosis and management of a rapidly evolving field vol.16, pp.9, 2010, https://doi.org/10.1038/s41569-019-0186-1
  5. Prognostic Value of N-Terminal Pro–B-Type Natriuretic Peptide in Elderly Patients With Valvular Heart Disease vol.75, pp.14, 2010, https://doi.org/10.1016/j.jacc.2020.02.031
  6. Integration of imaging and circulating biomarkers in heart failure: a consensus document by the Biomarkers and Imaging Study Groups of the Heart Failure Association of the European Society of Cardiolo vol.23, pp.10, 2010, https://doi.org/10.1002/ejhf.2339