B-type natriuretic peptide in organic mitral regurgitation: determinants and impact on outcome. Circulation 2005; 111: 2391–2397. letter to the Editor cohort studies of cardiovascular disease in the seychelles, tanzania and Mauritius We read with interest

Background—B-type natriuretic peptide (BNP) activation observed in cardiac diseases is a predictor of poor outcome; however, in organic mitral regurgitation (MR), BNP determinants and prognostic value are unknown. Methods and Results—We prospectively enrolled 124 patients with chronic organic MR (aged 6315 years, 60 % males) in whom we measured BNP level and simultaneously quantified MR degree, left ventricular (LV) remodeling, and left atrial (LA) volumes and analyzed long-term outcome. Baseline BNP level (5467 pg/mL, median 31 pg/mL) was associated univariately with multiple clinical and echocardiographic characteristics, but in multivariate analysis, independent determinants of BNP, beyond age and sex (both P0.01), were LV end-systolic volume index, LA volume, atrial fibrillation, and symptoms (all P0.02). Conversely, MR degree was not independently associated with BNP. During follow-up, patients with high versus low BNP (31 versus 31 pg/mL) displayed lower survival rates (at 5 years, 7210 % versus 955%, P0.03) and higher rates of the combined end point of death and heart failure (at 5 years, 4210 % versus 167%, P0.03). In multivariate analysis, with adjustment for age, sex, functional class, MR severity, and ejection fraction, BNP was independently predictive of mortality (hazard ratio per 10 pg/mL, 1.23 [95