Abstract
Introduction: 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. Methods: 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. Results: 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). Conclusion: 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.
Highlights
Natriuretic peptides are secreted from the heart in response to increased wall stress
There was no significant difference between patients in sinus rhythm (SR) and atrial fibrillation (AF) in terms of Mitral valve area (MVA), left atrial pressure (LAP), pulmonary artery pressure (PAP) and biomarker levels before and after procedure
MVA quantified by echocardiography was increased from 0.94 ± 0.22 cm[2] before Percutaneous transvenous mitral commissurotomy (PTMC) to 1.68 ± 0.39 cm[2] after the PTMC (P< 0.001)
Summary
Natriuretic peptides are secreted from the heart in response to increased wall stress. Rheumatic mitral stenosis (MS) remains a clinical problem in developing countries.[1] Percutaneous transvenous mitral commissurotomy (PTMC) was introduced in 1984 by Inoue and since has been performed increasingly as the treatment of choice for severe MS with favourable anatomy.[2] Natriuretic peptides are mainly secreted from the heart and released in response to increased wall stress.[3] BNP and NT-ProBNP are secreted both from the atria and the ventricles with the plasma half-life of 21 minutes and 60-120 minutes, respectively.[4] NT-proBNP levels are shown to correlate positively with the severity of the stenosis in patients with MS. We compared the changes in biomarker levels in patients with sinus rhythm (SR) and atrial fibrillation (AF)
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