ASSA13-08-13 Brain Natriuretic Peptide as a Predictor of Left Ventricle Reverse Remodelling After Cardiac Surgery

ObjectiveThere are a lot of articles in medical literature describing a brain natriuretic peptide (BNP) as a good predictor for outcomes in cardiac surgery. We sought to determine if the level of BNP in 3 – 5 years follow-up is prognostic predictor of left ventricle (LV) reverse remodelling and better clinical course of chronic heart failure (CHF). Methods One hundred and eight patients with coronary artery disease and left ventricle aneurisms were treated surgically between 2008 and 2011 in our centre. Medical records were reviewed retrospectively for clinical and echocardiographic data. All the patients have gone CABG and replied LV aneurisms. Most of patients have significantly decreased level of ejection fraction (EF - 40.8 ± 6.9%,) and high NYHA class of CHF (3.2 ± 0.3). All the patients have enlarged sizes of LV - end – diastolic volume (EDV) was 211.7 ± 40.9 ml. Some patients have mitral regurgitation (64/108, 59.2%) so suture annuloplasty were performed in that cases. Results Hospital mortality was 0%. All patients underwent clinical and echocardiographic follow-up at a mean follow-up period of 2.6 ± 1.2 years (median 2.8 years). Most of patients have been observed and treated in our centre by cardiologist. Overall survival was 92.2 ± 4.1% at 3.3 years. LV remodelling was demonstrated in all patients after the operation in 7 days: Both LV end-diastolic (from 211.7 ± 40.9 to 171.8 ± 34.6) and end-systolic volumes (ESV) (from 127.1 ± 36.1 to 94.8 ± 32.7 ml) indexed significantly decreased (both p = 0.0001) as EF have been increased from 40.8 ± 6.9% to 44.4 ± 7.9% (p < 0.05). But the most of patients after 3 years of follow – up we have seen significant increase in EDV and ESV, EF haven’t been changed (p < 0.001). The most of patient noticed the reduction of NYHA class of heart failure after 3 – years from the operation (3.2 ± 0.3 versus 0.8 ± 0.6, p < 0.001). All patients had significant increase in BNP level before surgery 215.0 ± 233.4 pg/ml. After 3 – year from operation we saw real decrease of BNP to 165.2 ± 92.7 pg/ml (p < 0.001). Multivariate statistical analysis demonstrated correlation of BNP level and CHF grade (EDV, ESV, EF, NYHA class) - hazard ratio (HR) 6.1, p = 0.005. Conclusions The cardiac surgery improves CHF, but this group of patients need constant therapy for reverse LV remodelling. BNP level characterise the prognosis CHF and the rightness of therapy.