PROGNOSTIC VALUE OF BRAIN NATRIURETIC PEPTIDE IN ASYMPTOMATIC PATIENTS WITH DEGENERATIVE MR -THE PROGRAM STUDY-

Abstract

Previous studies have shown that Brain natriuretic peptide (BNP) is predictive of survival in symptomatic patients with degenerative mitral regurgitation (MR). However little is known in asymptomatic patients with MR. The objective of this study was to examine the role of BNP in identifying patients who are at increased risk for adverse events and who may thus benefit from an early surgery. One hundred and twenty-six (126) asymptomatic patients (age 61±14 years, 52% men) with at least a moderate degenerative MR were prospectively recruited in the PROGRAM study from 2008 to 2016. Rest and stress echocardiography were performed. Plasma BNP levels were measured at rest, and expressed as BNPratio (ratio of measured BNP over the upper limit of normal BNP for age and sex of the patient). The primary study end-point was the composite of occurrence of mitral valve surgery, permanent atrial fibrillation, heart failure, hospitalization, or death. During a mean follow-up of 2.9±1.8 years there were 53 events (42%). Twenty one percent of patients had an increased BNPratio (i.e. >1). The 2-year event-free survival was lower in patients with a BNPratio >1 versus those with a BNPratio ≤ 1 (59.6±4% versus 82.7±17% p= 0.03). Univariable analysis showed that a BNPratio > 1 was associated with increased risk of cardiac events (HR: 2.8, 95% CI 1.55-5.08, p=0.001). After adjustment for MR severity, left ventricular ejection fraction (LVEF), and left atrial volume, BNPratio remained an independent predictor of cardiovascular events (HR: 2.46, P= 0.01). In this series of asymptomatic patients with at least moderate MR, BNPratio was a strong independent predictor of cardiac events. Thus, BNPratio may be useful to enhance risk stratification in asymptomatic MR and identify patients who may benefit from earlier mitral valve repair.