J Clin Med Res

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

**Table 1.** Natriuretic Peptides and Its Types
Natriuretic peptide	Amino acid length	T_1/2 (min)	Source	Stimulus 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; T_1/2: half life.
ANP	28	3	Atria	↑ atrial pressure, stretching
NANP	98	54	Atria	↑ atrial pressure, stretching
NT-ProBNP	76	60 - 120	Ventricles	↑ ventricular volume, stretching, end-diastolic pressure
BNP	32	22	Ventricles	↑ ventricular volume, stretching, end-diastolic pressure
CNP (two isoforms)	53, 22	42406	Peripheral vessel	Unclear

Table 1. Natriuretic Peptides and Its Types

Natriuretic peptide

Amino acid length

T_1/2 (min)

Source

Stimulus 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; T_1/2: half life.

ANP

Atria

↑ atrial pressure, stretching

NANP

Atria

↑ atrial pressure, stretching

NT-ProBNP

60 - 120

Ventricles

↑ ventricular volume, stretching, end-diastolic pressure

BNP

Ventricles

↑ ventricular volume, stretching, end-diastolic pressure

CNP (two isoforms)

53, 22

42406

Peripheral vessel

Unclear

**Table 2.** Baseline Characteristics of Patients (N = 223)
Variables	No. (%)
BNP: brain natriuretic peptide; MVP: mitral valve prolapse; HCM: hypertrophic cardiomyopathy.
Age (years)	31.2 ± 9
Sex (M:F)	153/73 (68/32)
Etiology
Rheumatic	201 (90)
MVP	17 (7.6)
HCM	5 (2.4)
BNP (pg/mL) at rest	65.24 ± 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 2. Baseline Characteristics of Patients (N = 223)

Variables

No. (%)

BNP: brain natriuretic peptide; MVP: mitral valve prolapse; HCM: hypertrophic cardiomyopathy.

Age (years)

31.2 ± 9

Sex (M:F)

153/73 (68/32)

Etiology

Rheumatic

201 (90)

MVP

17 (7.6)

HCM

5 (2.4)

BNP (pg/mL) at rest

65.24 ± 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)
Variables	T₁ (< 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 ± 11	31 ± 7	32 ± 8	0.3
Male, n (%)	53 (70)	53 (69)	46 (66)	0.6
Height (m)	1.53 ± 0.5	1.57 ± 0.2	1.56 ± 0.1	0.7
Weight (kg)	65 ± 12	63 ± 9.6	60 .7 ± 14	0.8
Treadmill test
Exercise time (min)	11.4 ± 1.73	11.4 ± 2.2	6.8 ± 1.6	< 0.01
Peak SBP (mm Hg)	159 ± 10	158 ± 12	150 ± 18	0.3
Increase in SBP (mm Hg)	47 ± 10	37 ± 8	35 ± 8	0.6
Peak HR	154 ± 8	151 ± 7	146 ± 10	0.2
Resting BNP (pg/mL)	30.3 ± 8.2	44.35 ± 17.2	124.5 ± 17.1	< 0.001
LV geometry and function at rest
Indexed LVESV (mL/m²)	21.5± 2.4	21.53 ± 2.6	22.69 ± 2.18	0.12
Indexed LVEDV (mL/m²)	68.7 ± 6.15	67.06 ± 4.77	67.44 ± 5	0.5
LVEF (%)	68.17 ± 3.14	66.7 ± 2.86	67.56 ± 3.16	0.6
LVGLS (%)	-23 ± 3	- 20 ± 4	- 17 ± 4	< 0.01
E/Ea ratio	11.65 ± 1.32	13.8 ± 1.01	15.05 ± 2.03	0.001
MR severity
ERO (mm²)	50.47 ± 6.2	59.94 ± 10.32	50.06 ± 9.24	0.08
RV (mL)	70.6 ± 4.17	87.53 ± 11.67	81.68 ± 10.27	0.5
Indexed LA volume (mL/m²)	36 ± 14	39 ± 14	54 ± 20	< 0.001
PASP (mm Hg)	33.41 ± 4.32	39.17 ± 4.38	44 ± 6.39	< 0.02

Table 3. Clinical and Echocardiographic Data According to Tertile of Peak eBNP Distribution (N = 223)

Variables

T₁ (< 15 to 44 pg/mL) (n = 76)

T₂ (45 - 104 pg/mL) (n = 77)

T₃ (105 - 400 pg/mL) (n = 70)

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 ± 11

31 ± 7

32 ± 8

0.3

Male, n (%)

53 (70)

53 (69)

46 (66)

0.6

Height (m)

1.53 ± 0.5

1.57 ± 0.2

1.56 ± 0.1

0.7

Weight (kg)

65 ± 12

63 ± 9.6

60 .7 ± 14

0.8

Treadmill test

Exercise time (min)

11.4 ± 1.73

11.4 ± 2.2

6.8 ± 1.6

< 0.01

Peak SBP (mm Hg)

159 ± 10

158 ± 12

150 ± 18

0.3

Increase in SBP (mm Hg)

47 ± 10

37 ± 8

35 ± 8

0.6

Peak HR

154 ± 8

151 ± 7

146 ± 10

0.2

Resting BNP (pg/mL)

30.3 ± 8.2

44.35 ± 17.2

124.5 ± 17.1

< 0.001

LV geometry and function at rest

Indexed LVESV (mL/m²)

21.5± 2.4

21.53 ± 2.6

22.69 ± 2.18

0.12

Indexed LVEDV (mL/m²)

68.7 ± 6.15

67.06 ± 4.77

67.44 ± 5

0.5

LVEF (%)

68.17 ± 3.14

66.7 ± 2.86

67.56 ± 3.16

0.6

LVGLS (%)

-23 ± 3

- 20 ± 4

- 17 ± 4

< 0.01

E/Ea ratio

11.65 ± 1.32

13.8 ± 1.01

15.05 ± 2.03

0.001

MR severity

ERO (mm²)

50.47 ± 6.2

59.94 ± 10.32

50.06 ± 9.24

0.08

RV (mL)

70.6 ± 4.17

87.53 ± 11.67

81.68 ± 10.27

0.5

Indexed LA volume (mL/m²)

36 ± 14

39 ± 14

54 ± 20

< 0.001

PASP (mm Hg)

33.41 ± 4.32

39.17 ± 4.38

44 ± 6.39

< 0.02

**Table 4.** Exercise Echocardiographic Data According to Tertiles of Peak eBNP Distribution (N = 223)
Variables	T₁ (< 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 ± 7	18 ± 8	26 ± 11	0.06
Indexed LVEDV (mL/m²)	58 ± 24	59 ± 19	66 ± 22	0.52
LVEF (%)	71 ± 9	69 ± 10	65 ± 13	0.13
LVGLS (%)	-27 ± 5	-23 ± 5	-17 ± 5	< 0.01
E/Ea ratio	13.52 ± 1.42	15.17 ± 0.81	18.87 ± 2.30	0.001
Exercise MR severity
ERO (mm²)	50.7 ± 10	55.1 ± 10.3	61 ± 12.38	0.04
RV (mL)	72 ± 5.9	82 ± 40	86 ± 34	0.09
Indexed LA volume (mL/m²)	42 ± 16	47 ± 18	52 ± 16	0.03
PASP (mm Hg)	59.06 ± 8.4	64.11 ± 7.4	74.7 ± 7.8	< 0.01

Table 4. Exercise Echocardiographic Data According to Tertiles of Peak eBNP Distribution (N = 223)

Variables

T₁ (< 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 ± 7

18 ± 8

26 ± 11

0.06

Indexed LVEDV (mL/m²)

58 ± 24

59 ± 19

66 ± 22

0.52

LVEF (%)

71 ± 9

69 ± 10

65 ± 13

0.13

LVGLS (%)

-27 ± 5

-23 ± 5

-17 ± 5

< 0.01

E/Ea ratio

13.52 ± 1.42

15.17 ± 0.81

18.87 ± 2.30

0.001

Exercise MR severity

ERO (mm²)

50.7 ± 10

55.1 ± 10.3

61 ± 12.38

0.04

RV (mL)

72 ± 5.9

82 ± 40

86 ± 34

0.09

Indexed LA volume (mL/m²)

42 ± 16

47 ± 18

52 ± 16

0.03

PASP (mm Hg)

59.06 ± 8.4

64.11 ± 7.4

74.7 ± 7.8

< 0.01