Additive prognostic values of NT-proBNP and exercise stress echocardiography in asymptomatic patients with degenerative mitral regurgitation and preserved left ventricular ejection fraction

作者：Park Sung Ji^*; Cho Eun Jeong; Ahn Joonghyun; Carriere Keumhee; Kim Eun Kyoung; Lee Ga Yeon; Chang Sung A; Choi Jin Oh; Lee Sang Chol; Park Seung Woo

来源：International Journal of Cardiology, 2017, 236: 387-392.

DOI：10.1016/j.ijcard.2017.02.063

• Mitral regurgitation
• Exercise echocardiography
• Asymptomatic
• NT-proBNP

Background: Exercise stress echocardiography (ESE) can be used to identify left ventricular (LV) dysfunction in asymptomatic chronic MR. NT-proBNP is the best marker for monitoring LV dysfunction.
Objective: The aim of this study was to estimate the complementary prognostic value of ESE and NT-proBNP in asymptomatic degenerative MR with preserved LV ejection fraction (EF).
Methods: Symptom-limited treadmill ESEwas performed in 114 asymptomaticwith significant degenerativeMR (ERO > 20 mm, RV > 30 ml), LV end-systolic diameter b40 mm and preserved LV EF N60%). Postexercise EF increase of >4% was defined as contractile reserve (CR)+.
Results: MV operation was performed in 19 (16.7%) and new-onset LV systolic dysfunction was developed in 23 (20.2%) patients over 3.5 +/- 1.5 years. Based on ROC curve analysis, a NT-pro BNP of 100 was deemed the most relevant cutoff value to predict primary outcome with Youden's index = 131.84. In sequential Cox models, a model based on clinical data and resting echocardiography variables (chi(2) = 6.87) was improved by NT-proBNP (chi(2) = 13.9) and presence of CR in ESE (chi(2)= 20.8; p = 0.0002).
Conclusions: In asymptomatic moderate to severe or severe degenerativeMR and preserved LVEF, the presence of CR in ESE and NT-proBNP provide important incremental clinical determinants. In particular, the prognosis is markedly poor for those with high NT-proBNP but with absence of CR than low NT-proBNP with presence of CR.

• 出版日期2017-6-1