Pre-operative, post-operative and 1-year follow-up N-terminal pro-B-type natriuretic peptide levels in severe chronic aortic regurgitation: correlations with echocardiographic findings

¹ Second University of Naples, Italy

^* To whom correspondence should be addressed. E-mail: aledellacorte{at}libero.it.

	Abstract

B-type natriuretic peptide is synthesized in response to increased ventricular wall stress (WS) and hypertrophy. To serially evaluate amino-terminal-pro-BNP (NT-pBNP) serum levels in patients undergoing aortic valve replacement (AVR) for severe chronic aortic regurgitation (AR), blood samples were drawn preoperatively, 15 days postoperatively, at 6- and 12-month follow-up in 25 consecutive patients. Two-dimensional echocardiography was performed concomitantly, assessing left ventricular (LV) dimensional and functional parameters, including WS. Correlations between NT-pBNP, clinical and echocardiographic data were assessed by non-parametric statistics. Median preoperative NT-pro-BNP was 276 pg/ml (IQR=85-1056), being normal or mildly increased in 20 patients, overly increased in 5. The most significant correlations of preoperative NT-pBNP were with diastolic (r=0.80, p<0.001) and systolic (r=0.75, p<0.001) meridional WS and inversely with time from symptom onset (r=-0.67, p=0.001). NT-pBNP increased 15 days post-operatively (568 pg/ml, p=0.006 versus preoperative), then decreased at 6 months (144 pg/ml, p<0.001) to remain stable at 1 year (108 pg/ml, p=0.16). Long-term follow-up NT-pBNP showed direct correlation with diastolic WS (r=0.56, p=0.02). Higher pre-operative levels of NT-pBNP predicted greater magnitude of total LV mass regression at follow-up (r=-0.65, p=0.002) independent of preoperative LV mass index, showing that NT-pBNP may have a potential prognostic usefulness in adjunct to echocardiography. Keywords: Aortic valve replacement; Chronic aortic regurgitation; B-type natriuretic peptide; Amino-terminal B-type natriuretic peptide; Left ventricular remodelling; Post-operative left ventricular mass regression

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