| Objective To summarize the changes and clinical features in peri-operation of N-terminal pro-brain natriuretic peptide(NT-proBNP),and to explore the clinical features of NT-proBNP and its relationship with left ventricular remodeling in patients with mitral stenosis and mitral regurgitation after mitral valve replacement(MVR).Methods This study enrolled 58 patients with mitral stenosis(MS group)and 60 patients with mitral regurgitation(MR group)who underwent MVR in the Department of Cardiac surgery General Hospital of Ningxia Medical University from May 2020 to May 2022.The relevant clinical data collected was analyzed by SPSS 26.0.Paired sample t-test,rank sum test and Spelman correlation analysis were used to summarize the clinical features in peri-operation of NT-proBNP and its relationship with left ventricular remodeling in patients who underwent mitral valve replacement.Results In MS group,the left ventricular end-diastolic diameter(LVEDD),(44.71±2.39)mm before operation,was significantly increased 6 months after MVR operation(48.12 ±4.22)mm(P<0.05),and the left ventricular ejection fraction(LVEF)was increased at 7 days and6 months after operation.In MR group,the LVEDD,(58.19±7.87)mm before operation,was significantly reduced at 7 days(50.31 ± 5.97)mm and 6 months(48.50 ± 5.70)mm after operation(P<0.05).The LVEF was(63.96±11.56)% before operation and(58.91±7.93)% at 7days after operation.Compared with 7 days after operation,the LVEF was increased at 6months(62.53±8.20)after opertaion(P < 0.05).The preoperative concentration of NT-proBNP in MS group was positively correlated with preoperative NYHA cardiac function grade and negatively correlated with preoperative LVEF.The concentration of NT-proBNP at 5 days after operation was negatively correlated with postoperative LVEF after operation;While in MR group,the preoperative concentration of NT-proBNP was positively correlated with NYHA cardiac function grade and left atrial diameter,and it was negatively correlated with LVEF.and the concentration of NT-proBNP at 5 days after operation was negatively correlated with postoperative LVEF after operation.The average level of NT-proBNP concentration increased at first and then decreased after operation.Conclusion 1.In patients whose main lesion were mitral stenosis,the left ventricle was slightly enlarged during the peri-operation after mitral valve replacement,and the left ventricle was enlarged and remodeled for a long time after operation,and the concentration of NT-proBNP began to decrease on the second day after operation,which may be related to the enlargement of left ventricle and the decrease of pressure on ventricular myocytes.2.In patients whose main lesion were mitral regurgitation,the left ventricle was shrunk and remodeled in peri-operation and long-term after mitral valve replacement,and the NT-proBNP concentration began to decrease on the 2nd day after operation,which may be related to the corresponding reduction of the anterior and posterior load of the ventricular cavity after the decrease of regurgitation.Preoperative NT-proBNP concentration has a certain clinical significance for the evaluation of preoperative cardiac function.3.Perioperative concentration of NT-proBNP has a certain clinical significance for the evaluation of preoperative cardiac function.Perioperative dynamic monitoring of NT-proBNP can understand the changes of cardiac function and evaluate the prognosis of patients.Postoperative concentration of NT-proBNP can not reflect the trend of left ventricular remodeling alone,but need to be combined with echocardiographic indicators for comprehensive analysis. |
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