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. 2013 Feb 28:8:32.
doi: 10.1186/1749-8090-8-32.

Ratio of preoperative atrial natriuretic peptide to brain natriuretic peptide predicts the outcome of the maze procedure in mitral valve disease

Masafumi Sato  1 , Akihito Mikamo, Hiroshi Kurazumi, Ryo Suzuki, Masanori Murakami, Toshiro Kobayashi, Koich Yoshimura, Kimikazu Hamano
Affiliations

Ratio of preoperative atrial natriuretic peptide to brain natriuretic peptide predicts the outcome of the maze procedure in mitral valve disease

Masafumi Sato et al. J Cardiothorac Surg. .

Abstract

Background: Although the maze procedure is an established surgical treatment for eliminating atrial fibrillation (AF), its efficacy in patients with mitral valve disease has remained unsatisfactory. A useful predictive marker for the outcome of the maze procedure is needed. The aim of this study was to investigate whether the preoperative ratio of atrial natriuretic peptide (ANP) to brain natriuretic peptide (BNP) reflects atrial fibrosis and can be used to predict the maze procedure outcome in patients with mitral valve disease.

Methods: A total of 23 consecutive patients who underwent the radial approach to the maze procedure combined with mitral valve surgery were included in this study and were divided into a sinus rhythm (SR) group (n=16) and an AF group (n=7) based on postoperative cardiac rhythm. Plasma samples were obtained at rest before the operation and were analysed for ANP and BNP levels. Atrial tissue samples taken during surgery were used to quantify interstitial fibrosis.

Results: The preoperative ANP-to-BNP ratio in the SR group was significantly higher than that in the AF group (0.74 +/- 0.29 vs. 0.42 +/- 0.28, respectively; p=0.025). Receiver operating characteristic (ROC) curve analysis was used to identify factors that predict outcomes after the maze procedure. The area under the ROC curve for the ANP-to-BNP ratio (0.81) was greater than for any other preoperative factors. Moreover, the preoperative ANP-to-BNP ratio demonstrated a negative correlation with left atrial fibrosis (r=-0.69; p=0.003).

Conclusions: The preoperative ANP-to-BNP ratio can predict maze procedure outcome in patients with mitral valve disease, and it represents a potential biomarker for left atrial fibrosis.

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Figures

Figure 1
Figure 1
ROC curve analysis in relation to the outcome after a maze operation. ANP: atrial natriuretic peptide; BNP: brain natriuretic peptide; CTR: cardiothoracic ratio; LAD: left atrial dimension.
Figure 2
Figure 2
Representative sections stained with 0.1% Sirius red and 0.1% Fast green in the left atrium (A, E), left atrial appendage (B, F), right atrium (C, G) and right atrial appendage (D, H) of patients with mild left atrial fibrosis (upper panel) and severe left atrial fibrosis (lower panel). Scale bar=200 μm.
Figure 3
Figure 3
Correlations between plasma ANP-to-BNP ratio and fibrosis (%) in the left atrium (A), left atrial appendage (B), right atrium (C) and right atrial appendage (D). ANP: atrial natriuretic peptide; BNP: brain natriuretic peptide.
Figure 4
Figure 4
Comparison between SR and AF groups for atrial fibrosis (%). SR: sinus rhythm; AF: atrial fibrillation.
See this image and copyright information in PMC

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