Table 4 CMR variables according to BNP levels The high BNP group showed worse survival after corrective surgery for isolated, severe TR Thirty-eight APO866 solubility dmso patients underwent tricuspid valve replacement and one patient underwent tricuspid valve repair and annuloplasty. The median duration of follow-up after surgery was 420 days Inhibitors,research,lifescience,medical (range, 11 – 780 days). Five of the 39 patients died after surgery (1 patient in the lower BNP group and 4 patients in the higher BNP group); all of 5 patients died due to congestive heart failure. Kaplan-Meier curves and log-rank analysis revealed

a significant difference between the 2 BNP groups (p = 0.001)(Fig. 2). The 1-year survival rate was 96 ± 4% in patients with a BNP < 200 pg/mL, and 53 ± 17% in patients with a BNP ≥ 200 pg/dL. Combined events, including Inhibitors,research,lifescience,medical death and readmission due to congestive heart failure, occurred in 12 among

39 patients during the follow-up period. The patients with BNP < 200 pg/mL had fewer events within 1 year following surgery. Kaplan-Meier survival curves and log-rank analysis showed a significant difference between the two groups during follow-up (p = 0.049)(Fig. 3). Fig. 2 Kaplan-Meier survival curve for death after surgery according to BNP level. BNP: B-type natriuretic peptide. Fig. 3 Kaplan-Meier survival curve for death and re-admission Inhibitors,research,lifescience,medical due to heart failure after surgery according to BNP level. BNP: B-type natriuretic peptide. Discussion Inhibitors,research,lifescience,medical This is the first study to determine the BNP levels in patients with severe, isolated TR in relation to CMR parameters, and to evaluate the role of BNP as a surrogate marker to predict future outcomes after surgery. We found that the following: (1) the BNP was determined by the LV EF and RV ESVI in patients with severe, isolated

TR; (2) a BNP ≥ 200 pg/mL was the best cut-off value to predicted poor outcome after corrective surgery; and (3) patients with a BNP ≥ 200 pg/mL had higher mortality and morbidity after surgery. Inhibitors,research,lifescience,medical The occurrence of functional TR after left-sided surgery is not an infrequently event and is well-known to be closely linked to exercise intolerance and to portend a poor prognosis.8),16),17) In an earlier study performed at our institution, corrective TR surgery was associated with a high operative mortality and morbidity.4) Therefore, the decision on whether or not to proceed to TR surgery is Sitaxentan difficult, which made us search hemodynamic parameters of echocardiography and CMR imaging predicting prognosis in patients with severe TR.3),4) In addition, we would like to have a simple and easily available surrogate marker to predict the prognosis of patients with severe, isolated TR. Patients with severe, isolated TR need repeated evaluation because the isolated functional TR normally occurs long after left-sided surgery.