Natriuretic Peptides in Cardiac Anesthesia and Intensive Care

Krichevskiy, Lev A.; Kozlov, I. A.

doi:10.1053/j.jvca.2018.08.019

Cited by 8 publications

(7 citation statements)

References 147 publications

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“…These findings suggest that release of hsTnI and BNP might be associated with each other and hsTnI release is activated partly by the increased cardiac strain (reflected by the high BNP) in response to various pathophysiological changes and/or stimuli of advanced liver disease, although the exact mechanism is unclear. It has been known that the physiological stimuli for myocardial production of BNP are an increase in preload and afterload and possibly myocardial ischemia [ 31 , 32 ]; further study will be needed to clarify their role in LT candidates. Indeed, 5.6% patients with both elevated BNP (≥ 400 pg/ml) and hsTnI (≥ 60 ng/L) showed higher MELD scores and suffered more severe comorbidities of advanced liver disease, such as renal replacement therapy, hepatic encephalopathy, and spontaneous bacterial peritonitis, compared with those with both biomarkers decreased ( Supplementary Table 1 ).…”

Section: Discussionmentioning

confidence: 99%

Preoperative high-sensitivity troponin I and B-type natriuretic peptide, alone and in combination, for risk stratification of mortality after liver transplantation

Moon

Kwon

Jung

et al. 2021

Korean J Anesthesiol

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Background: Given the severe shortage of donor liver graft, coupled with growing proportion of cardiovascular death after liver transplantation (LT), precise cardiovascular risk assessment is pivotal for selecting recipient who gains most survival benefit from LT surgery. We aimed to determine prognostic value of pre-LT combined measurement of B-type natriuretic peptide (BNP) and high-sensitivity troponin I (hsTnI) in predicting early post-LT mortality. Methods: We retrospectively evaluated 2,490 consecutive adult LT between 2010 and 2018. Cutoff values of BNP and hsTnI for predicting post-LT 90-day mortality were calculated. According to the derived cutoff values of two cardiac biomarkers, alone and in combination, adjusted hazard ratios (aHR) of post-LT 90-day mortality were determined using multivariate Cox regression analysis. Results: Mortality rate after 90-days was 2.9% (72/2,490). Rounded cutoff values for post-LT 90day mortality were 400 pg/ml for BNP (aHR 2.02 (1.15-3.52), P=0.014) and 60 ng/L for hsTnI [aHR 2.65 (1.48-4.74), P=0.001], respectively. Among 273 patients with BNP ≥400 pg/ml, 50.9% of patients were further stratified into having hsTnI ≥60 ng/L. Combined use of pre-LT cardiac biomarkers predicted post-LT 90-day mortality rate; both non-elevated: 1.0% (21/2,084), either one is elevated: 9.0% (24/267), and both elevated: 19.4% [27/139, log-rank P <0.001; aHR vs nonelevated 4.23 (1.98-9.03), P <0.001]. Conclusions: Concomitant elevation of both cardiac biomarkers posed significantly higher risk of 90-day mortality after LT. Pre-LT assessment cardiac strain and myocardial injury, represented by BNP and hsTnI values, would contribute to prioritization of LT candidates and help administer target therapies that could modify early mortality.

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Section: Discussionmentioning

confidence: 99%

Preoperative high-sensitivity troponin I and B-type natriuretic peptide, alone and in combination, for risk stratification of mortality after liver transplantation

Moon

Kwon

Jung

et al. 2021

Korean J Anesthesiol

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“…The perioperative kinetics of plasma NT-proBNP during cardiac surgery have been described (Reyes et al 2005). Although atrial natriuretic peptide (ANP) is not used in clinical practice as much as BNP/NT-proBNP (Krichevskiy and Kozlov 2019), there are data showing that ANP can be of clinical importance as a prognostic factor in cardiovascular disease (Alehagen et al 2013). In a previous study by Berendes on a cohort of patients undergoing cardiac surgery, they found an earlier increase in ANP compared to BNP (Berendes et al 2004).…”

Section: Discussionmentioning

confidence: 99%

“…II. Mid-regional pro-atrial natriuretic peptide (MR-proANP): Cleavage of the precursor proANP results in ANP and the more stable peptide MR-proANP, which is suitable for plasma measurements (Krichevskiy and Kozlov 2019). ANP is secreted into the circulation as a response to wall stretch in the atrial myocytes.…”

Section: Introductionmentioning

confidence: 99%

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Biomarker dynamics in cardiac surgery: a prospective observational study on MR-proADM, MR-proANP, hs-CRP and sP-selectin plasma levels in the perioperative period

et al. 2020

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Background: For many biomarkers in cardiac surgery, there is a lack of knowledge regarding the normal dynamics of plasma levels during the perioperative course. The aim of this study was to investigate the perioperative dynamics of MR-proADM, MR-proANP, hs-CRP and sP-selectin in cardiac surgery. Method: A prospective observational pilot study with 20 patients scheduled for open cardiac surgery procedures with cardiopulmonary bypass (CPB). Plasma samples were taken for each patient and biomarker during the pre-, per-and postoperative period until Day 6 postoperatively. Results: MR-proADM increased significantly from 0.62 [IQR; 0.54-0.93] nmol/L preoperatively to 1.20 [1.04-1.80] nmol/L postoperative Day 1. MR-proANP increased significantly from 125 [77-152] pmol/L preoperatively to 198 [168-307] pmol/L on weaning from CPB. hs-CRP increased significantly from 2.5 mg/L [0.4-12] preoperatively to peak at 208 mg/L [186-239] postoperative Day 3. The preoperative level of sP-selectin at 23.0 [21.3-26.3] ng/mL initially fell at weaning from CPB, followed by a significant peak of 25.5 [22.7-27.7] ng/mL 8 h postoperatively. Conclusions: The findings in this study may help to understand the physiology of the biomarkers analysed and their response to cardiac surgical trauma including CPB. Furthermore, these findings will guide us in further research on the clinical usefulness of these biomarkers.

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“…10 Postoperative events or complications relevantly associated with a patient's outcome and mortality are disregarded. For example, it has been shown that the extension of the EuroSCORE by postoperative concentrations of troponins or natriuretic peptides 10,11 allows for a better mortality prediction in cardiac surgery patients. Even when accounting for the EuroSCORE and the aforementioned biomarkers, the occurrence of postoperative complications greatly increased mortality.…”

mentioning

confidence: 99%

Re-exploration After Cardiac Surgery Impairs Outcome—But How to Stratify the Risk?

Bolliger

Mauermann

2019

Journal of Cardiothoracic and Vascular Anesthesia

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Natriuretic Peptides in Cardiac Anesthesia and Intensive Care

Cited by 8 publications

References 147 publications

Preoperative high-sensitivity troponin I and B-type natriuretic peptide, alone and in combination, for risk stratification of mortality after liver transplantation

Preoperative high-sensitivity troponin I and B-type natriuretic peptide, alone and in combination, for risk stratification of mortality after liver transplantation

Biomarker dynamics in cardiac surgery: a prospective observational study on MR-proADM, MR-proANP, hs-CRP and sP-selectin plasma levels in the perioperative period

Re-exploration After Cardiac Surgery Impairs Outcome—But How to Stratify the Risk?

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