N-Terminal ProBNP Levels Can Predict Cardiac Failure After Cardiac Surgery

Abstract

ardiac failure has a prevalence of 1% in people aged in their 50 s and 10% in their 80 s. The presence of cardiac failure symptoms in the preoperative period is known to increase the surgical risk and the postoperative mortality and morbidity. In recent years the introduction of new drugs and the increased use of coronary angioplasty and stent methods have enabled coronary heart operations to be performed in older patients and patients with late-stage disease. Thus determination of patient risk prior to operation has acquired importance.The plasma B-type natriuretic peptide (BNP) level varies according to the grade of heart failure; that is, it progressively increases from Grade I to Grade IV of the New York Heart Association classification and this increase in the secretion of natriuretic peptides is closely associated with left ventricular (LV) wall tension and ventricular filling pressure. 1 BNP, which is secreted because of increased LV wall tension, and its aminoterminal fraction N-terminal (NT)-proBNP, have gained a high value with respect to predicting LV function and its prognosis. 2,3 Of the natriuretic peptides, NT-proBNP particularly is accepted as a specific marker of cardiac failure 4 and in cases where the NT-proBNP level has increased above approximately 200 pg/ml, a diagnosis of cardiac failure may be made if there are also concomitant signs of cardiac failure. 5 Studies of the relationship between the severity of the heart failure after cardiac surgery and the requirement for inotropic agent, as related to the predictive use of NT-proBNP, are limited in the literature. Circulation Journal Vol.71, January 2007In the present study, the association between the preoperative NT-proBNP level and the prevalance and level of cardiac failure in the early postoperative period in patients undergoing coronary artery bypass grafting (CABG) was investigated. MethodsWe enrolled 52 adult patients undergoing elective CABG. In all patients the NT-proBNP level was measured via Elecys ProBNP sandwich immunoassay method on the day before surgery, and the normal value was accepted as <220 pg/ml. 6 Based on this we divided the patients into 2 groups: NT-proBNP level <220 pg/ml (Group A, n=26) or >220 pg/ml (Group B, n=26). Patients with renal failure (because a preoperative creatinine level >1.6 would cause an increase in the NT-proBNP level), acute myocardial infarction, or combined valvular disease and severe obstructive pulmonary disease were excluded.All the patients underwent CABG with standard cardiopulmonary bypass (CPB) techniques. The left internal mammary artery was used for revascularizing the left anterior descending coronary artery or a saphenous vein graft was used for the other coronary arteries. Arterial pressure was monitored via a radial artery cannula and cardiac rhythm was followed by the bedside monitor. The values for cardiac output (CO) and cardiac index (CI), pulmonary capillary wedge pressure (PCWP), pulmonary artery pressure (PAP), central venous pressure (CVP) were measured preoperatively an...

Amino Terminal Pro-B-Type Natriuretic Peptide and Late Left Ventricular Reverse Remodeling in Coronary Artery Bypass Grafting Patients with Low Ejection Fraction

“…31 Si mi larly, nu me ro us stu di es we re pub lis hed re por ting a cor re la ti on bet we en BNP levels and LV func ti on or out co me fol lo wing CABG. 4,8,10,18,22, The ef fects of co ro nary bypass on ven tric le di a me ters and sha pe ha ve not be en well-do cu men ted with lar ge stu di es. Sur gi cal Treat ment for Isc he mic He art Fa i lu re (STICH) in ves tiga tors re por ted 6% re duc ti on in left ven tri cu lar end systo lic vo lu me in dex at the fo urth pos to pe ra ti ve month fol lo wing CABG in pa ti ents with isc he mic car di om yo pathy.…”

“…[1][2][3][4][5][6][7][8][9][10] In the set ting of vo lu me ex pan si on or pres su re over lo ad, in cre a sing wall stress sti mu la tes synthesis of pre -p roBNP in the ven tri cu lar myo car di um. The re le a se of BNP re sults in furt her myo car di al re la xa ti on and exerts an im por tant re gu la tory ro le in res pon se to an acu te in cre a se in ven tri cu lar vo lu me by op po sing the va so cons tric ti on, so di um reten ti on, and an ti di u re tic ef fects of the ac ti va ted re nin-an gi o ten sin-al dos te ro ne system.…”

“…1,5,6,[10][11][12][13][14][15][16][17][18] Cur rently, BNP and NT-proBNP are rou ti nely used as di ag nos tic pa ra me ters in many cli nics' emer gency and in ten si ve ca re units.Re mode ling des cri bes struc tu ral chan ges of he art af ter myo car di al in farc ti on, and can be di vi ded to early and la te pha ses. Early pha se oc curs wit hin the first thre e days fol lo wing myo car di al in farc ti on (MI), and the la te pha se oc curs af ter the third day of MI.…”

Increased B-type Natriuretic Peptide (NT-proBNP) Level as a Risk Factor in Cardiosurgical Patients

“…Информативность повышенного содержания в крови NT proBNP, как пре диктора осложнений и смертности у больных хрониче ской недостаточностью кровообращения и ишемичес кой болезнью сердца (ИБС), не вызывает сомнений [2][3][4]. В этой связи, вполне закономерен интерес к оценке NT proBNP при прогнозировании риска опера ций с искусственным кровообращением (ИК) по пово ду ИБС [5,6]. Получены данные, подтверждающие вли яние степени повышения NT proBNP на клиническое течение и исходы операций с ИК.…”

“…Однако вопрос об уровне биомаркера, который следует рассматривать как фактор риска при операциях с ИК, остается не ясным. Предиктором сердечной недостаточности после ревас куляризации миокарда одни авторы считают концент рацию более 400 пг/мл [7,8], другие приводят значение 220 пг/мл [5]. Есть данные, что на повышенный риск операций указывает концентрация пептида 500 и даже 600 пг/мл [7,9].…”