J Cardiovasc Ultrasound.  2010 Dec;18(4):139-145. 10.4250/jcu.2010.18.4.139.

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

Affiliations
  • 1Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea.
  • 2Cardiovascular Center, Seoul National University Boramae Hospital, Seoul, Korea. jooheezo@brm.co.kr
  • 3Cardiovascular Center, Seoul National University Hospital, Seoul, Korea.
  • 4Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
  • 5Department of Thoracic Surgery, Seoul National University College of Medicine, Seoul, Korea.

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, R2 = 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 > or = 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.

Keyword

B-type natriuretic peptide; Tricuspid regurgitation; Surgery; Cardiac magnetic resonance

MeSH Terms

Death
Heart
Heart Failure
Heart Valve Diseases
Heart Ventricles
Humans
Linear Models
Magnetic Resonance Spectroscopy
Natriuretic Peptide, Brain
Plasma
Prospective Studies
ROC Curve
Sensitivity and Specificity
Stroke Volume
Survival Rate
Tricuspid Valve Insufficiency
Natriuretic Peptide, Brain

Figure

  • Fig. 1 ROC curve for determining cut-off value to predict outcome after surgery. ROC: receiver operating characteristic.

  • Fig. 2 Kaplan-Meier survival curve for death after surgery according to BNP level. BNP: B-type natriuretic peptide.

  • Fig. 3 Kaplan-Meier survival curve for death and re-admission due to heart failure after surgery according to BNP level. BNP: B-type natriuretic peptide.


Cited by  1 articles

Tricuspid Regurgitation: Clinical Importance and Its Optimal Surgical Timing
Hyung-Kwan Kim, Seung-Pyo Lee, Yong-Jin Kim, Dae-Won Sohn
J Cardiovasc Ultrasound. 2013;21(1):1-9.    doi: 10.4250/jcu.2013.21.1.1.


Reference

1. Czer LS, Maurer G, Bolger A, DeRobertis M, Kleinman J, Gray RJ, Chaux A, Matloff JM. Tricuspid valve repair. Operative and follow-up evaluation by Doppler color flow mapping. J Thorac Cardiovasc Surg. 1989. 98:101–110. 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–I19.
Article
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. 31:1520–1528.
Article
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. 120:1672–1678.
Article
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. 20:577–582.
Article
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. 98:659–661.
Article
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. 8:567–574.
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. 98:236–242.
Article
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. 87:1402–1412.
Article
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–S187.
Article
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. 45:402–405.
Article
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. 31:116–125.
Article
13. Isnard R. NT-BNP/BNP for screening left ventricular hypertrophy in hypertension: what else? Arch Cardiovasc Dis. 2008. 101:295–297.
Article
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. 111:2391–2397.
Article
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. 54:1099–1106.
Article
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.
Article
17. Nath J, Foster E, Heidenreich PA. Impact of tricuspid regurgitation on long-term survival. J Am Coll Cardiol. 2004. 43:405–409.
Article
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. 9:892–896.
Article
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. 147:218–223.
Article
20. Koskenvuo JW, Järvinen V, Pärkkä JP, Kiviniemi TO, Hartiala JJ. Cardiac magnetic resonance imaging in valvular heart disease. Clin Physiol Funct Imaging. 2009. 29:229–240.
Article
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