Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access
Article copyright, the authors; Journal compilation copyright, J Clin Med Res and Elmer Press Inc
Journal website http://www.jocmr.org

Original Article

Volume 8, Number 11, November 2016, pages 797-804


Prognostic Importance of Exercise Brain Natriuretic Peptide in Asymptomatic Chronic Organic Severe Mitral Regurgitation: An Observational Study

Tables

Table 1. Natriuretic Peptides and Its Types
 
Natriuretic peptideAmino acid lengthT1/2 (min)SourceStimulus for release
ANP: atrial natriuretic peptide; NANP: N-terminal atrial natriuretic peptide; NT-ProBNP: N-terminal pro­B-type natriuretic peptide; BNP: B-type natriuretic peptide; CNP: C-type natriuretic peptide; T1/2: half life.
ANP283Atria↑ atrial pressure, stretching
NANP9854Atria↑ atrial pressure, stretching
NT-ProBNP7660 - 120Ventricles↑ ventricular volume, stretching, end-diastolic pressure
BNP3222Ventricles↑ ventricular volume, stretching, end-diastolic pressure
CNP (two isoforms)53, 2242406Peripheral vesselUnclear

 

Table 2. Baseline Characteristics of Patients (N = 223)
 
VariablesNo. (%)
BNP: brain natriuretic peptide; MVP: mitral valve prolapse; HCM: hypertrophic cardiomyopathy.
Age (years)31.2 ± 9
Sex (M:F)153/73 (68/32)
Etiology
  Rheumatic201 (90)
  MVP17 (7.6)
  HCM5 (2.4)
BNP (pg/mL) at rest65.24 ± 43.92 (median: 43.5)
BNP (pg/mL) at exercise (eBNP)100.24 ± 98.24 (median: 66.5)
  T1 (15 - 44)76 (34%)
  T2 (45 - 104)77 (34%)
  T3 (105 - 400)70 (31%)

 

Table 3. Clinical and Echocardiographic Data According to Tertile of Peak eBNP Distribution (N = 223)
 
VariablesT1 (< 15 to 44 pg/mL) (n = 76)T2 (45 - 104 pg/mL) (n = 77)T3 (105 - 400 pg/mL) (n = 70)P
SBP: systolic blood pressure; ERO: effective regurgitant orifice; HR: heart rate; LVESV: left ventricular end-systolic volume; LVEDV: left ventricular end-diastolic volume; LVEF: left ventricular ejection fraction; GLS: global longitudinal strain; PASP: pulmonary artery systolic pressure; RV: regurgitant volume.
Age (years)29 ± 1131 ± 732 ± 80.3
Male, n (%)53 (70)53 (69)46 (66)0.6
Height (m)1.53 ± 0.51.57 ± 0.21.56 ± 0.10.7
Weight (kg)65 ± 1263 ± 9.660 .7 ± 140.8
Treadmill test
  Exercise time (min)11.4 ± 1.7311.4 ± 2.26.8 ± 1.6< 0.01
  Peak SBP (mm Hg)159 ± 10158 ± 12150 ± 180.3
  Increase in SBP (mm Hg)47 ± 1037 ± 835 ± 80.6
  Peak HR154 ± 8151 ± 7146 ± 100.2
  Resting BNP (pg/mL)30.3 ± 8.244.35 ± 17.2124.5 ± 17.1< 0.001
LV geometry and function at rest
  Indexed LVESV (mL/m2)21.5± 2.421.53 ± 2.622.69 ± 2.180.12
  Indexed LVEDV (mL/m2)68.7 ± 6.1567.06 ± 4.7767.44 ± 50.5
  LVEF (%)68.17 ± 3.1466.7 ± 2.8667.56 ± 3.160.6
  LVGLS (%)-23 ± 3- 20 ± 4- 17 ± 4< 0.01
  E/Ea ratio11.65 ± 1.3213.8 ± 1.0115.05 ± 2.030.001
MR severity
  ERO (mm2)50.47 ± 6.259.94 ± 10.3250.06 ± 9.240.08
  RV (mL)70.6 ± 4.1787.53 ± 11.6781.68 ± 10.270.5
  Indexed LA volume (mL/m2)36 ± 1439 ± 1454 ± 20< 0.001
  PASP (mm Hg)33.41 ± 4.3239.17 ± 4.3844 ± 6.39< 0.02

 

Table 4. Exercise Echocardiographic Data According to Tertiles of Peak eBNP Distribution (N = 223)
 
VariablesT1 (< 15 - 44 pg/mL) (n = 77)T2 (45 - 104 pg/mL) (n = 76)T3 (105 - 400 pg/mL) (n = 70)P value
ERO: effective regurgitant orifice; HR: heart rate; LVESV: left ventricular end-systolic volume; LVEDV: left ventricular end-diastolic volume; LVEF: left ventricular ejection fraction; GLS: global longitudinal strain; PASP: pulmonary artery systolic pressure; RV: regurgitant volume.
LV geometry and function at exercise
  Indexed LVESV (mL/m2)18 ± 718 ± 826 ± 110.06
  Indexed LVEDV (mL/m2)58 ± 2459 ± 1966 ± 220.52
  LVEF (%)71 ± 969 ± 1065 ± 130.13
  LVGLS (%)-27 ± 5-23 ± 5-17 ± 5< 0.01
  E/Ea ratio13.52 ± 1.4215.17 ± 0.8118.87 ± 2.300.001
Exercise MR severity
  ERO (mm2)50.7 ± 1055.1 ± 10.361 ± 12.380.04
  RV (mL)72 ± 5.982 ± 4086 ± 340.09
  Indexed LA volume (mL/m2)42 ± 1647 ± 1852 ± 160.03
  PASP (mm Hg)59.06 ± 8.464.11 ± 7.474.7 ± 7.8< 0.01