BACKGROUND: The
plasma B-type natriuretic peptide (BNP) level is a useful prognostic marker in
heart failure and
valvular heart disease . In
patients with isolated severe
tricuspid regurgitation (TR), little is known about the determinants of
plasma BNP levels and the correlation with
future outcome. The purpose of this study was to identify the determinants of
plasma BNP levels in
patients with isolated severe TR and the value of the BNP level in predicting postoperative outcomes after corrective
surgery .
METHODS: We prospectively enrolled 39
patients with isolated, severe TR undergoing corrective
surgery . A
plasma BNP assay and cardiac
magnetic resonance (CMR) imaging were performed before
surgery . The combined end-point was the occurrence of
cardiac death or readmission due to
heart failure .
RESULTS: Linear regression analysis showed that the left
ventricular ejection fraction and right
ventricular end systolic volume were the most important determinants of the BNP levels (p = 0.002, R2 = 0.315). Based on the
receiver operating characteristics (ROC) curve, we were able to derive an optimal cutoff value (200 pg/mL) to predict postoperative
cardiac death with a
sensitivity of 80% and a
specificity of 85%. The one-year
survival rate was 96% in
patients with a BNP or = 200 pg/dL (p = 0.001).
CONCLUSION: An elevation in the BNP level is determined by the
functional status of the right and
left ventricles in
patients with isolated, severe TR. An elevated BNP predicts adverse events after corrective
surgery . Therefore, the BNP level should be included in the clinical evaluation and
risk stratification of
patients with isolated TR.