Correlation Of Left Ventricular Remodeling And Perioperative NT-proBNP In Patients With Aortic Stenosis And Aortic Regurgitation

Objective To determine the characteristics of changes of N-terminal pro brain natriuretic peptide(NT-pro BNP)in patients with aortic stenosis and aortic regurgitation during the perioperative period;The correlation between perioperative NT-pro BNP level and left ventricular remodeling and its diagnostic value for left ventricular reverse remodeling after aortic valve replacement(AVR);At the same time,the characteristics of left ventricular remodeling in patients with aortic valve stenosis and aortic valve regurgitation will be identified.Methods A total of 72 patients with aortic regurgitation and aortic stenosis who underwent aortic valve replacement in the Department of Cardiovascular Surgery of General Hospital of Ningxia Medical University from July 2020 to June 2022 were selected as objects,including 49 patients in the aortic regurgitation group and 23 patients in the aortic stenosis group.The preoperative,intraoperative,and postoperative clinical data were collected.Results One week and six months after aortic valve replacement,the left ventricular mass index and left ventricular end diastolic diameter of patients with aortic regurgitation decreased compared with those before operation(P<0.05).In patients with aortic regurgitation,preoperative NT-pro BNP level was positively correlated with preoperative cardiac function classification,left ventricular mass index before operation,one week after operation and six months after operation,left ventricular end diastolic diameter before operation and one week after operation,and negatively correlated with left ventricular ejection fraction one week after operation(P<0.05).One week and six months after aortic valve replacement,the left ventricular mass index and left ventricular end diastolic diameter in patients with aortic stenosis were lower than those before surgery(P<0.05).In the aortic stenosis group,the preoperative NT-pro BNP level was positively correlated with preoperative cardiac function grading,with preoperative,postoperative one week and six months’ left ventricular mass index,with preoperative left ventricular end diastolic diameter,and negatively correlated with preoperative,postoperative one week and six months’ left ventricular ejection fraction(P<0.05).Conclusion 1.In patients with aortic regurgitation,left ventricular reverse remodeling can occur within 1 week after valve replacement,which is reflected in the decrease of left ventricular mass index and end diastolic diameter;2.The patients with aortic stenosis also experienced reverse remodeling of the left ventricle within one week after valve replacement.The left ventricular mass index and end diastolic diameter decreased,but to a lesser extent;3.The postoperative level of NT-pro BNP showed a trend of first increasing and then decreasing,and the levels were higher at different time periods after surgery than before.Patients with high levels of NT-pro BNP in the preoperative plasma did not perform as well as patients with low concentrations of NT-pro BNP in the process of left ventricular reverse remodeling after surgery,and this situation persisted until 6 months after surgery;4.The preoperative NT-pro BNP level in the aortic regurgitation group can play a diagnostic role in patients with postoperative left ventricular reverse remodeling.The diagnostic value is lower than the preoperative left ventricular mass index,but higher than the left ventricular mass index one week after surgery.The optimal cut-off value of NT-pro BNP before aortic regurgitation is688.4pg/ml;5.The preoperative NT-pro BNP level in the aortic stenosis group can play a diagnostic role in patients with postoperative left ventricular reverse remodeling,but the diagnostic value is not as good as the left ventricular mass index before and 1 week after surgery.The optimal cut-off value of NT-pro BNP before aortic valve stenosis surgery is 1106pg/ml.