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Natriuretic Peptide Release during Exercise in Patients with Valvular Heart Disease: a Systematic Review.
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  • Sveeta Badiani,
  • Jet van Zalen,
  • Aeshah Althunayyan,
  • Sahar Al-borikan,
  • Thomas Treibel,
  • Andrew Marshall,
  • Nikhil Patel,
  • Sanjeev Bhattacharyya,
  • Guy Lloyd
Sveeta Badiani
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Jet van Zalen
Eastbourne District General Hospital
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Aeshah Althunayyan
Barts Health NHS Trust
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Sahar Al-borikan
Barts Health NHS Trust
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Thomas Treibel
Barts Health NHS Trust
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Andrew Marshall
Eastbourne District General Hospital
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Nikhil Patel
Eastbourne District General Hospital
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Sanjeev Bhattacharyya
Barts Health NHS Trust
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Guy Lloyd
Barts Health NHS Trust
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Abstract

Aims Serum biomarkers have a potential role in the risk stratification of patients with heart valve disease and may help determine the optimal timing of intervention. Much of the published literature relates to biomarker sampling in a resting state, but the relationship of exercise biomarkers is less well described. We performed a systematic review to examine the significance of exercise natriuretic peptides on echocardiographic variables and cardiovascular events, in valvular heart disease. Methods A search for studies that assessed exercise biomarkers in patients with moderate to severe valve lesions was performed. We examined the relationship between rest and exercise BNP and also the endpoints of symptoms, haemodynamic or echocardiographic variables and clinical outcomes. Results 11 prospective studies were identified (844 participants). 61% were male and the mean age was 55.2 ± 9.6 years. The majority of the blood samples were taken at baseline and within 3 minutes of stopping exercise. There was a significant increase in exercise BNP compared with rest, in patients with aortic stenosis, mitral regurgitation and mitral stenosis. Elevated exercise BNP levels correlated with mean gradient and left atrial area, and there was a relationship between a higher exercise BNP and a blunted blood pressure response, in aortic stenosis. Furthermore, exercise BNP was independently associated with cardiac events, over and above resting values, in patients with mitral regurgitation and aortic stenosis. Conclusions The results suggesting that exercise natriuretic peptide levels may have additive prognostic importance over resting levels, as well as demographic and echocardiographic data.

Peer review status:ACCEPTED

18 Nov 2020Submitted to International Journal of Clinical Practice
17 Dec 2020Submission Checks Completed
17 Dec 2020Assigned to Editor
18 Dec 2020Reviewer(s) Assigned
18 Jan 2021Review(s) Completed, Editorial Evaluation Pending
30 Jan 20211st Revision Received
01 Feb 2021Submission Checks Completed
01 Feb 2021Assigned to Editor
01 Feb 2021Reviewer(s) Assigned
28 Feb 2021Review(s) Completed, Editorial Evaluation Pending
02 Mar 2021Editorial Decision: Accept