Vol 68, No 1 (2010)
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Published online: 2010-02-03

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Original article
Complimentary roles for N-terminal pro-B-type natriuretic peptide and spirometry to assess functional capacity in patients with complex mixed heart valve disease

Naylin Bissessor, Yong Shen Wee, Rohan Jayasinghe, Irene Zeng, Boris Lowe, John Kolbe, Kevin Ellyet, Andrew Kerr, Harvey White, Ralph Stewart
DOI: 10.33963/v.kp.79964
Kardiol Pol 2010;68(1):1-10.

Abstract

Background: Assessing the effects of valvular heart disease on functional capacity is important for optimal timing of surgery.
Aim: To determine whether N-terminal pro-B type natriuretic peptide (NT-proBNP) and lung spirometry predict maximum oxygen consumption (pVO2) on cardio-pulmonary exercise testing in patients with mixed heart valve disease.
Methods: Forty-five clinically stable patients with moderate-severe stenosis and/or regurgitation of the aortic, mitral and/or tricuspid valves were studied. The ability of echocardiography, NT-proBNP, forced expiratory volume in one second (FEV1) and forced vital capacity (FVC) to predict impaired pVO2 was determined.
Results: On univariate analysis the natural logarithm of NT-proBNP explained more of the variation in pVO2 (r2 = 0.40, p < 0.0001) than valve severity score (r2 = 0.20, p = 0.002), pulmonary artery pressure (r2 = 0.21, p = 0.005), left atrial area index (r2 = 0.25, p = 0.001) or LV ejection fraction (r2 = 0.02, p = 0.4). Low lean body weight (r2 = 0.21, p = 0.002), FEV1 (r2 = 0.26, p = 0.0003) and FVC (r2 = 0.20, p = 0.002) were also associated with pVO2. In multi-variable analysis independent determinants of pVO2 were NT-proBNP (r2 = 0.27, p = 0.001), FVC (r2 = 0.20, p = 0.0002) and lean body weight (r2 = 0.23, p = 0.001). NT-proBNP and FVC together were better predictors of pVO2 < 60% (C statistic = 0.83, 95% CI 0.71, 0.95) than either NT-proBNP (C = 0.80, 95% CI 0.66, 0.94) or FVC (C =0.73, 95% CI 0.57, 0.89) alone. NT-proBNP, FVC and age also predicted excessive ventilation on cardio-pulmonary exercise (combined r2 = 0.54, p < 0.0001).
Conclusion: In patients with mixed heart valve disease NT-proBNP and spirometry provide a more reliable assessment of functional capacity than assessment by echocardiography and symptoms alone.

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Polish Heart Journal (Kardiologia Polska)