Increased Perioperative N-Terminal Pro-B-Type Natriuretic Peptide Levels Predict Atrial Fibrillation After Thoracic Surgery for Lung Cancer

Abstract

Background-Postoperative atrial fibrillation (AF) is a complication of thoracic surgery for lung cancer, with a reported incidence that can run as high as 42%. Recently, it has been observed retrospectively that B-type natriuretic peptide predicts AF after cardiac surgery. We performed a prospective study to evaluate the role of N-terminal pro-B-type natriuretic peptide (NT-proBNP) as a marker for risk stratification of postoperative AF in patients undergoing thoracic surgery for lung cancer. Methods and Results-We measured NT-proBNP levels in 400 patients (mean age, 62Ϯ10 years; 271 men) 24 hours before and 1 hour after surgery. The primary end point of the study was the incidence of postoperative AF. Overall, postoperative AF occurred in 72 patients (18%). Eighty-eight patients (22%) showed an elevated perioperative NT-proBNP value. When patients with either preoperatively or postoperatively elevated NT-proBNP were pooled, a greater incidence of AF was observed compared with patients with normal values (64% versus 5%; PϽ0.001). At multivariable analysis, adjusted for age, gender, major comorbidities, echocardiography parameters, pneumonectomy, and medications, both preoperative and postoperative NT-proBNP values were independent predictors of AF (relative risk, 27.9; 95% CI, 13.2 to 58.9; PϽ0.001 for preoperative NT-proBNP elevation; relative risk, 20.1; 95% CI, 5.8 to 69.4; PϽ0.001 for postoperative NT-proBNP elevation). Conclusions-Elevation of perioperative NT-proBNP is a strong independent predictor of postoperative AF in patients undergoing thoracic surgery for lung cancer. This finding should facilitate studies of therapies to reduce AF in selected high-risk patients.

Safety of Landiolol Infusion in Patients Undergoing Lung Resection

“…This may have been because patients were only followed up for 48 hours postoperatively despite the fact that arrhythmic events including AF can often occur 70 hours after surgery, as reported by Shiroya et al [7]. Cardinale et al [15] also reported that the peak of AF onset was on the second postoperative day. Further studies with a sufficient observation period are warranted to verify our findings.…”

O peptídeo natriurético do tipo B é preditor de eventos em pós-operatório de cirurgia ortopédica

“…The utility of the natriuretic peptides BNP and N-terminal pro-BNP fraction (NT-proBNP) in predicting postoperative cardiac events has been reported in the past years both in studies including several types of non-cardiac surgery and in specific surgeries. In all of them, these markers stood out as the only independent predictor or one of the main independent predictors of the postoperative risk [6][7][8][9][10] . Dernellis and Panaretou analyzed the preoperative value of BNP in risk prediction in 1,590 patients undergoing different types of non-cardiac surgery 6 .…”

“…The study population showed baseline characteristics similar to those of the present study, and the cut-off point obtained was closer to that found in our study. Similarly to BNP, NT-proBNP was able to predict cardiac complications in patients undergoing surgical treatment of abdominal aortic aneurysm 7 ; in high-risk patients undergoing several types of non-cardiac surgeries 10 ; and in the prediction of the incidence of atrial fibrillation following thoracic surgery for the treatment of lung cancer 9 . Our study corroborates previous findings in a specific population of patients undergoing orthopedic surgery.…”

Preoperative B-type natriuretic peptides in patients undergoing noncardiac surgery: a cumulative meta-analysis

“…In total, 24 of the 28 studies 29,[34][35][36][37][38][40][41][42][43][46][47][48][49][50][51][52][53][55][56][57][58][59][60] were prospective observational cohort studies. Of the remaining four studies: …”

“…Of the remaining studies, three reported exclusively on patients undergoing emergency surgery, 38,45,48 and one documented both elective and emergency surgeries that were classified as being high risk. 46 Certain studies investigated outcomes in a specific surgical discipline, including thoracic surgery (4), 36,50,51,54 vascular (7), 29,40,42,44,55,57,59 orthopaedic (5), 45,[47][48][49]60 major abdominal (1), 56 oesophagectomy (1), 41 while the rest documented outcomes following a variety of surgeries performed (10), 34,35,[37][38][39]43,46,52,53,58 including a mix of general, head and neck, gynaecological, orthopaedic, vascular, urological, neurosurgery and thoracic surgery.…”