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Eur J Cardiothorac Surg 2007;31:922-928. doi:10.1016/j.ejcts.2007.01.038
Copyright © 2007, European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved

Changes in B-type natriuretic peptides after surgical ventricular restoration

^a Department of Cardiothoracic Surgery and Anesthesiology, Karolinska University Hospital, Stockholm, Sweden
^b Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
^c Department of Clinical Physiology, Karolinska Institutet at Södersjukhuset, Stockholm, Sweden
^d Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden

Received 17 November 2006; received in revised form 21 January 2007; accepted 23 January 2007.

^_* Corresponding author at: Department of Cardiothoracic Surgery and Anesthesiology, Karolinska University Hospital, SE-171 76 Stockholm, Sweden. Tel.: +46 8 517 728 94; fax: +46 8 33 19 31. (Email: Ulrik.Sartipy{at}karolinska.se).

Objective: The aim of this study was to prospectively investigate changes in brain natriuretic peptide (BNP) and amino terminal pro-BNP (NT-pro-BNP) in relation to functional status after surgical ventricular restoration (SVR). Methods: Between March 2003 and May 2006, 29 patients (20 men and 9 women, mean age 65 years, mean ejection fraction 24%) with post-infarction left ventricular aneurysm and depressed left ventricular function underwent SVR according to the Dor technique at our institution. Twenty-two patients (76%) were in New York heart association (NYHA) functional class III or IV. Multi-vessel disease was present in 26 patients. Natriuretic peptides, functional status, ejection fraction and left ventricular volumes were analyzed at baseline, after 6 months, and late postoperatively. Results: There was no early mortality. Survival at 24 months was 93%. Six months postoperatively 25/29 (86%) patients were in NYHA class I and II (p < 0.001) and at late (mean 21 months) follow-up, all patients were in NYHA class I and II. There was a persistent reduction of NT-pro-BNP (2406 pg/ml vs 1510 pg/ml; p = 0.03 and 975 pg/ml; p = 0.03) and BNP (312 pg/ml vs 228 pg/ml; p = 0.12 and 191 pg/ml; p = 0.20) 6 months postoperatively and at late follow-up, respectively. Ejection fraction improved from 24% to 37% (p < 0.001) at 6 months. End-diastolic (110 ml/m² vs 90 ml/m², p = 0.009) and end-systolic (75 ml/m² vs 52 ml/m², p = 0.006) volume index were reduced at 6 months. Functional improvement correlated significantly with reduction in BNP (r = 0.61, p = 0.01) and NT-pro-BNP (r = 0.58, p = 0.003) 6 months after surgery. Ejection fraction correlated inversely with BNP (r = –0.58, p = 0.02) and NT-pro-BNP (r = –0.51, p = 0.04), and end-systolic volume correlated with BNP (r = 0.65, p = 0.03) and NT-pro-BNP (r = 0.62, p = 0.03) 6 months after surgery. Conclusions: Heart failure secondary to post-infarction left ventricular remodeling can be reversed by SVR. Improvement in these patients was associated with reduced levels of B-type natriuretic peptides 6 months after surgery. Clinical improvement was maintained and peptide levels were further reduced at late follow-up.

Key Words: Left ventricular reconstruction • Surgical ventricular restoration • Ventricular remodeling • Natriuretic peptides • Ischemic heart disease • Congestive heart failure

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