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Natriuretic peptides in the evaluation and management of degenerative mitral regurgitation: a systematic review
  1. Michael M Johl1,
  2. Pankaj Malhotra1,
  3. Devin W Kehl2,
  4. Florian Rader2,
  5. Robert J Siegel2
  1. 1 Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
  2. 2 Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
  1. Correspondence to Robert J Siegel, Heart Institute, Cedars-Sinai Medical Center, 127 S San Vincente Blvd, AHSP A3417, Los Angeles, CA 90048, USA; Robert.Siegel{at}cshs.org

Abstract

Progression of degenerative mitral regurgitation (MR) leads to irreversible cardiac damage. Therefore, longitudinal follow up to determine the optimal timing of surgery is critical. Current data indicates that in addition to the standard of care—assessing for symptoms and signs of left ventricular (LV) decompensation with routine echocardiography—serial measurement of natriuretic peptides offers a quantitative means to identify patients who may benefit from closer supervision, if not surgery. Natriuretic peptide levels, and specifically changes from baseline, identify both symptomatic patients and others likely to develop cardiac dysfunction. Moreover, because natriuretic peptides are complimentary to the echocardiographic assessment of MR. Finally, changes in natriuretic peptides levels are predictive of pre- and post-operative outcomes. In short, natriuretic peptides add objectivity to the management of degenerative MR, which may aid practitioners in identifying patients who could benefit from intensive monitoring, stress testing, and perhaps mitral surgery.

  • B-type natriuretic peptide
  • NT-pro-B-type natriuretic peptide
  • Degenerative mitral regurgitation
  • Mitral valve surgery
  • Timing

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Footnotes

  • Contributors The authors have reviewed and approved the submission of this manuscript. This manuscript is original and is not under consideration for publication elsewhere. MMJ and PM participated in the design, analysis, writing and revision of the manuscript. They are responsible for the overall content. DWK participated in the analysis and writing of the manuscript. FR and RJS participated in the design, analysis and writing of the manuscript.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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