Utility of B-type natriuretic peptide in predicting perioperative cardiac events in patients undergoing major non-cardiac surgery †

Abstract

In the setting of major non-cardiac surgery, preoperative BNP levels are higher in patients who experience perioperative death and myocardial injury. Larger studies are required to confirm these data and to clarify what BNP levels may add to existing methods of risk stratification.

B‐type natriuretic peptide and C‐terminal‐pro‐endothelin‐1 for the prediction of severely impaired peak oxygen consumption

“…This assumption is supported by the prognostic value of BNP in various settings [32][33][34][35]. The optimal BNP cut-off in this study and also in a recent study evaluating the utility of BNP to predict perioperative complications after major noncardiac surgery (40 pg mL )1 ) [36] were lower than cut-offs for evaluation of possible HF in dyspnoeic patients in the emergency department (100 pg mL )1 ) [30], which illustrates that BNP cut-off values critically depend on the setting.…”

“…Similarly to BNP in the evaluation of acute dyspnoea [30], the strength of BNP, CT-proET-1 and the proposed score lies in the high negative predictive value. Given that BNP has been shown to predict events after noncardiac surgery [36], it is tempting to speculate that CT-proET-1 could be at least similarly useful for preoperative risk assessment. This, however, needs to be tested prospectively.…”

The role of brain natriuretic peptide in prognostication and reclassification of risk in patients undergoing vascular surgery*

“…This could be considered as a reasonable extension to the current AHA pre-operative cardiovascular evaluation algorithm [9]. A recent study highlighted the need to evaluate the utility of pre-operative B-type natriuretic peptides in peri-operative risk stratification [12]. We believe that we have fulfilled the fourth requirement proposed by the AHA in the evaluation of pre-operative BNP for elective vascular surgical risk prediction whereby the use of pre-operative BNP would significantly change the risk classification of a patient and hence the clinical therapy required [1].…”

New practice guidelines for perioperative beta blockade from the United States and Europe: incremental progress or a necessary evil?

“…Nonetheless, it appears to be robust in its ability to predict major adverse outcome (particularly with modification in terms of other variables, such as age or aneurysm size and the extremes of the cumulative number of predictor variables); it is easy to use and involves no expense. [29][30][31][32] Although there are a host of other sensitive and more specific predictors, primarily new biomarkers, such as the naturetic peptides or inflammatory reactive proteins, these involve considerable additional expense when applied to many patients. 33 The committee discounts the efficacy of ''minor predictors'', including the Framingham long-term cardiac risk variables used in the original atenolol study by Mangano et al, thus reducing the pool of eligible candidates.…”

“…Cependant, cet indice semble être à même de bien prédire les complications majeures (particulièrement lors de modifications d'autres variables, comme l'âge ou la taille de l'anévrisme et les extrêmes du nombre cumulé des variables de prédiction); enfin, il est facile à utiliser et ne coûte rien. [29][30][31][32] Bien qu'il existe une multitude d'autres prédicteurs sensibles et plus spécifiques, principalement des nouveaux biomarqueurs tels que les peptides natriurétiques ou les protéines réactives inflammatoires, ces prédicteurs engendrent d'importants coûts supplémentaires lorsqu'ils sont appliqués à un nombre important de patients. 33 Le comité ne tient pas compte de l'efficacité des « prédicteurs mineurs », notamment des variables de risque cardiaque à long terme de Framingham utilisées dans l'étude originale sur l'aténolol de Mangano et coll., ce qui réduit encore plus le bassin de candidats potentiels.…”