NT-proBNP in Mitral Stenosis: Can It Be a Predictor of Hemodynamic Status?

Mitral valve area (MVA) and other indices of the severity of mitral stenosis poorly reflect the functional status, systolic pulmonary artery pressure, and cardiac output in patients with severe mitral stenosis. In the present study, we aimed to compare the strength of conventional stenosis indices and N-terminal pro B-type natriuretic peptide (NT-proBNP) levels in the prediction of major functional and hemodynamic consequences of mitral stenosis in a group of patients with a severe form of this disease.  

Patients with severe symptomatic rheumatic mitral stenosis (MVA< 1.5 cm2) were enrolled. Comprehensive echocardiography and catheterization were performed for all the patients. MVA was measured via the 2D planimetry method, and NT-proBNP levels were measured during admission.  

Forty-one patients, 88% of whom were female, were enrolled in our study. The NT-proBNP level and MVA had a significantly negative correlation (ρ= −0.450 and P =0.003). The NT-proBNP level had a significant correlation with systolic pulmonary artery pressure (ρ= −0.423 and P = 0.006) and MV resistance (ρ= −0.506 and P = 0.001); however, the mean transmitral pressure gradient and the NT-proBNP level did not show a significant relationship. The strongest relationships were found between the NT-proBNP level and stroke volume and cardiac output, which were negatively significant (P = −0.601 and P = 0.000) and (ρ= −0.587 and P = 0.000), respectively.  

It appears that the NT-proBNP level can be a good predictor of patients’ hemodynamic status such as cardiac output in addition to the echocardiographic features of mitral stenosis. (Iranian Heart Journal 2020; 21(3): 98-104)