经皮冠状静脉窦二尖瓣环成形术后患者的B型利钠肽

B-type natriuretic peptide in patients after percutaneous trans-coronary-sinus mitral annuloplasty.

作者信息

Siminiak Tomasz, Jerzykowska Olga, Kuzemczak Michał, Szyszka Andrzej, Kałmucki Piotr, Baszko Artur

机构信息

HCP Medical Centre, Poznan University of Medical Sciences, Poznan, Poland.

出版信息

Kardiol Pol. 2014;72(5):446-51. doi: 10.5603/KP.a2014.0017. Epub 2014 Feb 14.

DOI:10.5603/KP.a2014.0017

PMID:24526552

Abstract

BACKGROUND AND AIM

Functional mitral regurgitation (MR) remains a significant clinical problem. Surgical valve repair carries a high procedural risk. Thus, percutaneous techniques are under development. One of the most advanced devices for percutaneous mitral annuloplasty (PTMA) is the Carillon™ device. B-type natriuretic peptide (BNP) is a marker of haemodynamic status in heart failure patients. So far, its usefulness in patients after PTMA is unknown.

METHODS

Thirteen consecutive patients after successful implantation of the Carillon™ device were enrolled. PTMA was achieved through the coronary sinus in order to improve leaflet coaptation. Before PTMA, immediately after, and at one month follow-up, transthoracic echocardiography was performed. Furthermore, plasma BNP levels, the six-minute walk test (6MWT) and the Naughton treadmill exercise test were evaluated before PTMA and after one month.

RESULTS

In patients after successful PTMA, significant improvement in echocardiographic parameters was maintained at one-month follow-up: vena contracta (0.31 ± 0.03 vs. 0.64 ± 0.03 cm, p < 0.05), effective regurgitant orifice area (0.2 ± 0.02 vs. 0.32 ± 0.05 cm², p < 0.05), MR jet area/left atrial area (32.33 ± 1.98 vs. 47.06 ± 2.3%,p < 0.05) and regurgitant volume (27.84 ± 2.17 vs. 45.25 ± 7.47 mL, p < 0.05). Both the duration of the exercise test (4.3 ± 0.45 vs. 3.12 ± 0.18 min, p < 0.05) and 6MWT (320 ± 29.63 vs. 295.2 ± 13.4 m, p < 0.05) improved. Furthermore, improvement of the NYHA class was observed. Despite that, mean BNP levels remained unchanged (405.3 ± 133.9 vs. 596.5 ± 245.2 pg/mL, p = 0.191; after and before the procedure, respectively). In some patients with device located above the annulus level, an increase in BNP leve ls was observed.

CONCLUSIONS

BNP seems to be useless for the assessment of patients after PTMA. This may be related to mechanical stress on the annulus and atrial wall caused by the device itself.

摘要

背景与目的

功能性二尖瓣反流（MR）仍是一个重大的临床问题。外科瓣膜修复手术具有较高的手术风险。因此，经皮技术正在研发中。用于经皮二尖瓣环成形术（PTMA）的最先进设备之一是Carillon™装置。B型利钠肽（BNP）是心力衰竭患者血流动力学状态的标志物。到目前为止，其在PTMA术后患者中的作用尚不清楚。

方法

连续纳入13例成功植入Carillon™装置的患者。通过冠状窦进行PTMA以改善瓣叶对合。在PTMA前、术后即刻及术后1个月随访时，进行经胸超声心动图检查。此外，在PTMA前及术后1个月评估血浆BNP水平、6分钟步行试验（6MWT）和诺顿平板运动试验。

结果

成功进行PTMA的患者在1个月随访时，超声心动图参数仍有显著改善：缩流颈（0.31±0.03 vs. 0.64±0.03 cm，p<0.05）、有效反流口面积（0.2±0.02 vs. 0.32±0.05 cm²，p<0.05）、MR射流面积/左心房面积（32.33±1.98 vs. 47.06±2.3%，p<0.05）和反流容积（27.84±2.17 vs. 45.25±7.47 mL，p<0.05）。运动试验持续时间（4.3±0.45 vs. 3.12±0.18 min，p<0.05）和6MWT（320±29.63 vs. 295.2±13.4 m，p<0.05）均有所改善。此外，纽约心脏协会（NYHA）心功能分级也有改善。尽管如此，平均BNP水平仍无变化（分别为术后和术前405.3±133.9 vs. 596.5±245.2 pg/mL，p = 0.191）。在一些装置位于瓣环水平上方的患者中，观察到BNP水平升高。