Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
Can J Cardiol. 2013 Jun;29(6):704-11. doi: 10.1016/j.cjca.2012.09.006. Epub 2012 Dec 4.
B-type natriuretic peptide (BNP) is a useful biomarker of cardiac function in patients with mitral regurgitation (MR). However, the change in BNP in association with rhythm status after corrective surgery has not been studied.
A total of 101 patients with chronic severe MR undergoing surgery were prospectively enrolled. BNP assays and echocardiographic studies were conducted before and 6 months after surgery. Patients were divided into 3 groups according to pre- and postoperative rhythm (sinus to sinus [SS], n = 61; atrial fibrillation [AF] to sinus [AS], n = 28; AF to AF [AA], n = 12).
BNP decreased only in the AS group 6 months after mitral surgery (from 218.0 ± 136.5 to 94.7 ± 85.1 pg/mL; P < 0.001) but not in the SS or AA groups (P for interaction = 0.001). However, changes of echocardiographic parameters after surgery were not different among the 3 groups. In the AA group, postoperative left ventricular (LV) end-diastolic dimension and left atrial volume were higher than the other groups. Significant determinants of BNP were the presence of AF and the higher pulmonary artery systolic pressure preoperatively (β = 0.767 and P = 0.001 for AF; β = 0.022 and P = 0.019 for pulmonary artery systolic pressure), and the lower LV ejection fraction postoperatively (β = -0.030; P = 0.011).
After surgical correction of chronic organic severe MR, BNP decreased only in patients with preoperative AF which was converted to sinus rhythm postoperatively. A reduction in BNP was not observed when rhythm status did not change. BNP activation was associated with the presence of AF and LV systolic dysfunction, suggesting its prognostic value.
B 型利钠肽（BNP）是二尖瓣反流（MR）患者心功能的有用生物标志物。然而，校正手术后 BNP 与节律状态变化之间的关系尚未研究。
前瞻性纳入 101 例慢性重度 MR 行手术治疗的患者。术前和术后 6 个月进行 BNP 检测和超声心动图检查。根据术前和术后节律（窦性心律至窦性心律 [SS]，n = 61；心房颤动至窦性心律 [AS]，n = 28；心房颤动至心房颤动 [AA]，n = 12）将患者分为 3 组。
仅在 AS 组二尖瓣手术后 6 个月时 BNP 降低（从 218.0 ± 136.5 降至 94.7 ± 85.1 pg/ml；P < 0.001），但 SS 或 AA 组无变化（P 组间差异 = 0.001）。然而，术后超声心动图参数变化在 3 组之间无差异。AA 组术后左心室（LV）舒张末期内径和左心房容积高于其他组。BNP 的显著决定因素是术前存在 AF 和较高的肺动脉收缩压（AF 的 β = 0.767 和 P = 0.001；肺动脉收缩压的 β = 0.022 和 P = 0.019），以及术后较低的 LV 射血分数（β = -0.030；P = 0.011）。
慢性有机重度 MR 手术后校正后，仅在术前存在 AF 且术后转为窦性心律的患者中 BNP 降低。当节律状态未改变时，未观察到 BNP 降低。BNP 的激活与 AF 和 LV 收缩功能障碍有关，提示其具有预后价值。
