Changes in B-type natriuretic peptides after surgical ventricular restoration

Sartipy, Ulrik; Albåge, Anders; Larsson, Per Thomas; Insulander, Per; Lindblom, Dan
May 2007
European Journal of Cardio-Thoracic Surgery;May2007, Vol. 31 Issue 5, p923
Academic Journal
Abstract: Objective: The aim of this study was to prospectively investigate changes in brain natriuretic peptide (BNP) and amino terminal pro-BNP (NT-pro-BNP) in relation to functional status after surgical ventricular restoration (SVR). Methods: Between March 2003 and May 2006, 29 patients (20 men and 9 women, mean age 65 years, mean ejection fraction 24%) with post-infarction left ventricular aneurysm and depressed left ventricular function underwent SVR according to the Dor technique at our institution. Twenty-two patients (76%) were in New York heart association (NYHA) functional class III or IV. Multi-vessel disease was present in 26 patients. Natriuretic peptides, functional status, ejection fraction and left ventricular volumes were analyzed at baseline, after 6 months, and late postoperatively. Results: There was no early mortality. Survival at 24 months was 93%. Six months postoperatively 25/29 (86%) patients were in NYHA class I and II (p <0.001) and at late (mean 21 months) follow-up, all patients were in NYHA class I and II. There was a persistent reduction of NT-pro-BNP (2406pg/ml vs 1510pg/ml; p =0.03 and 975pg/ml; p =0.03) and BNP (312pg/ml vs 228pg/ml; p =0.12 and 191pg/ml; p =0.20) 6 months postoperatively and at late follow-up, respectively. Ejection fraction improved from 24% to 37% (p <0.001) at 6 months. End-diastolic (110ml/m2 vs 90ml/m2, p =0.009) and end-systolic (75ml/m2 vs 52ml/m2, p =0.006) volume index were reduced at 6 months. Functional improvement correlated significantly with reduction in BNP (r =0.61, p =0.01) and NT-pro-BNP (r =0.58, p =0.003) 6 months after surgery. Ejection fraction correlated inversely with BNP (r =−0.58, p =0.02) and NT-pro-BNP (r =−0.51, p =0.04), and end-systolic volume correlated with BNP (r =0.65, p =0.03) and NT-pro-BNP (r =0.62, p =0.03) 6 months after surgery. Conclusions: Heart failure secondary to post-infarction left ventricular remodeling can be reversed by SVR. Improvement in these patients was associated with reduced levels of B-type natriuretic peptides 6 months after surgery. Clinical improvement was maintained and peptide levels were further reduced at late follow-up.


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