The Journal of Thoracic and Cardiovascular Surgery
Adult: CoronaryPrognostic value of natriuretic peptides and restrictive filling pattern before surgical ventricular restoration
Graphical abstract
Section snippets
Methods
This is a retrospective analysis of the data of the Biomarker Plus study (protocol No. 2703/78) regarding ICM patients assigned to SVR at the Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Donato.10 Patients, undergoing SVR from June 2012 to December 2016, for whom there were complete echocardiographic and NT-proBNP data before surgery were selected for the present study. Exclusion criteria were atrial fibrillation or other persistent cardiac rhythm alterations (n = 7),
Results
Table 1 presents baseline clinical data for the entire population as a whole and the 4 groups. We note that group 1 (low NT-proBNP and no RFP) presents the longest time lapse between myocardial infarction (MI) and SVR and the lowest average New York Heart Association functional class. Creatinine values and average New York Heart Association functional class were highest in the 2 groups (2 and 4) with high NT-proBNP. Group 2 (high NT-proBNP but no RFP) presents a remarkably short time lapse
Discussion
As illustrated in Figure 4, this study shows that combined use of a biological and a functional index of heart failure provides additional prognostic information in patients with ICM undergoing SVR. Moreover, it helps to individuate different pattern of structural LV remodeling in patients with ICM despite similar volumes, mass, and ejection fraction.
Beyond the diagnostic and prognostic role that NPs play in chronic congestive HF in general, even in patients with ICM and established HF NPs have
Conclusions
The simultaneous use of 2 markers, 1 biological and 1 echocardiographic, may allow better stratification of prognosis and characterization of the distinct structural and clinical phenotypes in a population of patients with ICM undergoing SVR. This study highlights the importance of an integrated approach, based on biological markers, instrumental parameters, and careful clinical evaluation in the clinical decision making to guide therapeutic choices in patients with ICM.
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Partially supported by Ricerca Corrente funding from Italian Ministry of Health to Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Donato.