Pourafkari Leili, Seyedhosseini Seyedrazi, Kazemi Babak, Esmaili Heydarali, Aslanabadi Naser
Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
Department of Pathology, Tabriz University of Medical Sciences, Tabriz, Iran.
J Cardiovasc Thorac Res. 2014;6(3):175-9. doi: 10.15171/jcvtr.2014.007. Epub 2014 Sep 30.
Natriuretic peptides are secreted from the heart in response to increased wall stress. Their levels are expected to be increased in patients with mitral stenosis (MS) due to high left atrium (LA) pressure and pulmonary artery pressure (PAP). Percutaneous transvenous mitral commissurotomy (PTMC) if successful is pursued by a rapid decrease in LA pressure and subsequent decrease in pulmonary artery pressure. The concurrent changes in natriuretic peptide levels could be affected with heart rhythm.
Forty five patients with severe rheumatic MS undergoing PTMC were enrolled. We evaluated the serum NT-Pro BNP levels before and 24 hours after PTMC. BNP levels were also measured from the blood samples obtained from LA before and 20 minutes after the procedure. Changes in biomarkers were assessed based on heart rhythm and success of the procedure.
While serum NT-Pro BNP levels showed significant decrease 24 hours after the procedure (P= 0.04), BNP levels taken 20 minutes after PTMC from LA were similar to their baseline concentrations (P= 0.26). NT-Pro BNP levels decreased 51.7±182.86 pg/ml for sinus rhythm (SR) and 123.4±520 pg/ml for atrial fibrillation (AF) (P= 0.68).
Immediate changes in BNP levels did not predict the success of procedure probably due to the additional balloon inflation attempts in LA in several patients and half-life of BNP. BNP levels obtained later may be of more value considering the half-life of this marker. Heart rhythm was not found to influence the changes in biomarker levels. BNP and NT-pro BNP changes were not found to predict success of the procedure.
利钠肽是心脏在壁应力增加时分泌的。由于左心房（LA）压力和肺动脉压力（PAP）升高，预计二尖瓣狭窄（MS）患者的利钠肽水平会升高。经皮经静脉二尖瓣交界切开术（PTMC）如果成功，会使LA压力迅速下降，随后肺动脉压力也下降。利钠肽水平的同时变化可能会受到心律的影响。
纳入45例接受PTMC的重度风湿性MS患者。我们评估了PTMC术前和术后24小时的血清NT-Pro BNP水平。还在术前和术后20分钟从LA采集的血样中测量BNP水平。根据心律和手术成功率评估生物标志物的变化。
虽然术后24小时血清NT-Pro BNP水平显著下降（P = 0.04），但PTMC术后20分钟从LA采集的BNP水平与基线浓度相似（P = 0.26）。窦性心律（SR）时NT-Pro BNP水平下降51.7±182.86 pg/ml，房颤（AF）时下降123.4±520 pg/ml（P = 0.68）。
BNP水平的即刻变化可能无法预测手术的成功，这可能是由于部分患者在LA进行了额外的球囊扩张尝试以及BNP的半衰期所致。考虑到该标志物的半衰期，稍后获得的BNP水平可能更有价值。未发现心律会影响生物标志物水平的变化。未发现BNP和NT-pro BNP的变化可预测手术的成功。
