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COMPARISON OF ATRIAL AND B-TYPE NATRIURETIC PEPTIDE IN MITRAL AND AORTIC VALVE DISEASE
S8
Heart, Lung and Circulation 2008;17S:S1–S34
Abstracts
ABSTRACTS
Young Pts
Old Pts
P Value
% Pts with ≥15% Risk Score
doi:10.1016/j.hlc.2008.03.016
(+5% FH)
16%
32%
0.0019
(×1.5 FH)
19%1
33%2
0.0098
(×2.0 FH)
28%3
37%4
0.12
1
P = 0.0082
2
P = 0.32
3
P < 0.0001
4
P = 0.046 vs. NZ score
This equates to 23 lives during this period or more than 3 lives saved per year.
Conclusion: A simple adjustment for a FH of premature CVS risk might better identify young people who subsequently suffer an ACS. doi:10.1016/j.hlc.2008.03.015 15 DEATHS ON THE CARDIAC SURGERY WAITING LIST BD Mahon Wellington Hospital, Wellington, New Zealand Background: Limited access to cardiac surgery in the New Zealand makes deaths on the waiting list for cardiac surgery inevitable. There is very limited published data regarding the number and timing of such deaths in New Zealand. Methods: Department records of all patients accepted in principle for cardiac surgery from 1 January 2001 to 31 December 2007, at a New Zealand tertiary hospital were reviewed. Patients who died on the waiting list were identified and their waiting period was calculated. The mortality rate for patients while waiting was estimated, noting that until this cohort have all had an outcome (surgery, death on waiting list or removed from list) this estimate can only be an under estimate of the true mortality rate. Results: During this 7 year period, of the 3891 patients accepted for surgery, 38 patients died while awaiting surgery. This includes those who died before all the preoperative work-up was completed, i.e. before “Certainty” was reached. Thirteen percent of the patient deaths were in the first 2 days after acceptance for surgery. Almost a quarter of patients died in the first week, 42% in the first month, 61% within 3 months, 74% within 6 months and 95% within the first year. Five percent of patients who died while waiting had waited more than a year. Conclusion: Almost 1% of patients accepted for cardiac surgery died prior to surgery with a quarter of these deaths in the first week. One in four deaths could be avoided if no patient waited more than 6 months for cardiac Surgery in New Zealand. The number of deaths could be reduced by 39% if no patient waited more than 3 months.
16 COMPARISON OF ATRIAL AND B-TYPE NATRIURETIC PEPTIDE IN MITRAL AND AORTIC VALVE DISEASE A Kerr 1,∗ , NC Van Pelt 2 , RS Gabriel 2 , V Sharma 2 , OC Raffel 2 , G Whalley 3 , RAH Stewart 2 1 Cardiology
Department, Middlemore Hospital, Auckland, New Zealand 2 Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand 3 Cardiovascular Research Laboratory, University of Auckland, Auckland, New Zealand Background: It is not clear whether atrial natriuretic peptide (ANP) provides additional diagnostic information to B-type NP (BNP) in patients with heart valve disease. Methods: ANP and BNP were measured in patients with moderate-severe mitral stenosis (MS, n = 30), mitral regurgitation (MR, n = 33), aortic stenosis (AS, n = 34), aortic regurgitation (AR, n = 39) and normal controls (n = 47). All subjects had a normal left ventricular (LV) ejection fraction (>50%) by echocardiography. Left atrial (LA) area was indexed to body surface area. Results: Both ANP and BNP were higher in patients with MS, MR and AS than in normal controls (for all p < 0.01). BNP increased in AR but ANP was similar to controls. The increase in ANP relative to BNP expressed as LnANP/LnBNP is presented in the table. In normal controls LnANP increased with increase in LA area (r = 0.46, p = 0.001) but LnBNP did not (r = −0.01, p = 0.95). However in all patients with heart valve disease LnBNP (r = 0.54, p < 0.0001) as well as LnANP (r = 0.64, p < 0.0001) increased with increase in LA area. Conclusion: Both ANP and BNP increase in MS, MR and AS which cause substantially different pressure and volume loads on the LV and LA. While BNP was not associated with LA size in health, increase in BNP with heart valve disease may reflect changes in both atrial and ventricular function. Results are median * or mean ± S.D. Normal
Mitral Stenosis
ANP (pmol/L)*
12 (9.7, 16) 36 (27, 53)
BNP (pmol/L)*
6.2 (4.5, 8)
Mitral Regurgitation 30 (23, 38)
17 (9.8, 26) 10 (6.5, 15)
LnANP/LnBNP 1.41 ± 0.35 1.32 ± 0.24 1.57 ± 0.43
doi:10.1016/j.hlc.2008.03.017
Aortic Regurgitation
Aortic Stenosis
12 (8.1, 20)
24 (17, 32)
9.9 (6.4, 12.9)
9.1 (6.5, 17)
1.13 ± 0.22
1.43 ± 0.30
Heart, Lung and Circulation 2008;17S:S1–S34
Abstracts
ABSTRACTS
Young Pts
Old Pts
P Value
% Pts with ≥15% Risk Score
doi:10.1016/j.hlc.2008.03.016
(+5% FH)
16%
32%
0.0019
(×1.5 FH)
19%1
33%2
0.0098
(×2.0 FH)
28%3
37%4
0.12
1
P = 0.0082
2
P = 0.32
3
P < 0.0001
4
P = 0.046 vs. NZ score
This equates to 23 lives during this period or more than 3 lives saved per year.
Conclusion: A simple adjustment for a FH of premature CVS risk might better identify young people who subsequently suffer an ACS. doi:10.1016/j.hlc.2008.03.015 15 DEATHS ON THE CARDIAC SURGERY WAITING LIST BD Mahon Wellington Hospital, Wellington, New Zealand Background: Limited access to cardiac surgery in the New Zealand makes deaths on the waiting list for cardiac surgery inevitable. There is very limited published data regarding the number and timing of such deaths in New Zealand. Methods: Department records of all patients accepted in principle for cardiac surgery from 1 January 2001 to 31 December 2007, at a New Zealand tertiary hospital were reviewed. Patients who died on the waiting list were identified and their waiting period was calculated. The mortality rate for patients while waiting was estimated, noting that until this cohort have all had an outcome (surgery, death on waiting list or removed from list) this estimate can only be an under estimate of the true mortality rate. Results: During this 7 year period, of the 3891 patients accepted for surgery, 38 patients died while awaiting surgery. This includes those who died before all the preoperative work-up was completed, i.e. before “Certainty” was reached. Thirteen percent of the patient deaths were in the first 2 days after acceptance for surgery. Almost a quarter of patients died in the first week, 42% in the first month, 61% within 3 months, 74% within 6 months and 95% within the first year. Five percent of patients who died while waiting had waited more than a year. Conclusion: Almost 1% of patients accepted for cardiac surgery died prior to surgery with a quarter of these deaths in the first week. One in four deaths could be avoided if no patient waited more than 6 months for cardiac Surgery in New Zealand. The number of deaths could be reduced by 39% if no patient waited more than 3 months.
16 COMPARISON OF ATRIAL AND B-TYPE NATRIURETIC PEPTIDE IN MITRAL AND AORTIC VALVE DISEASE A Kerr 1,∗ , NC Van Pelt 2 , RS Gabriel 2 , V Sharma 2 , OC Raffel 2 , G Whalley 3 , RAH Stewart 2 1 Cardiology
Department, Middlemore Hospital, Auckland, New Zealand 2 Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand 3 Cardiovascular Research Laboratory, University of Auckland, Auckland, New Zealand Background: It is not clear whether atrial natriuretic peptide (ANP) provides additional diagnostic information to B-type NP (BNP) in patients with heart valve disease. Methods: ANP and BNP were measured in patients with moderate-severe mitral stenosis (MS, n = 30), mitral regurgitation (MR, n = 33), aortic stenosis (AS, n = 34), aortic regurgitation (AR, n = 39) and normal controls (n = 47). All subjects had a normal left ventricular (LV) ejection fraction (>50%) by echocardiography. Left atrial (LA) area was indexed to body surface area. Results: Both ANP and BNP were higher in patients with MS, MR and AS than in normal controls (for all p < 0.01). BNP increased in AR but ANP was similar to controls. The increase in ANP relative to BNP expressed as LnANP/LnBNP is presented in the table. In normal controls LnANP increased with increase in LA area (r = 0.46, p = 0.001) but LnBNP did not (r = −0.01, p = 0.95). However in all patients with heart valve disease LnBNP (r = 0.54, p < 0.0001) as well as LnANP (r = 0.64, p < 0.0001) increased with increase in LA area. Conclusion: Both ANP and BNP increase in MS, MR and AS which cause substantially different pressure and volume loads on the LV and LA. While BNP was not associated with LA size in health, increase in BNP with heart valve disease may reflect changes in both atrial and ventricular function. Results are median * or mean ± S.D. Normal
Mitral Stenosis
ANP (pmol/L)*
12 (9.7, 16) 36 (27, 53)
BNP (pmol/L)*
6.2 (4.5, 8)
Mitral Regurgitation 30 (23, 38)
17 (9.8, 26) 10 (6.5, 15)
LnANP/LnBNP 1.41 ± 0.35 1.32 ± 0.24 1.57 ± 0.43
doi:10.1016/j.hlc.2008.03.017
Aortic Regurgitation
Aortic Stenosis
12 (8.1, 20)
24 (17, 32)
9.9 (6.4, 12.9)
9.1 (6.5, 17)
1.13 ± 0.22
1.43 ± 0.30