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

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

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 (r 2 = 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 (r 2 = 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 (r 2 = 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.

Original languageEnglish
Pages (from-to)1-10
Number of pages10
JournalKardiologia Polska
Volume68
Issue number1
Publication statusPublished - 2010
Externally publishedYes

Keywords

  • Aortic valve
  • BNP
  • Cardio-pulmonary testing
  • Mitral valve
  • Spirometry

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