Relationship between B-type natriuretic peptide levels and echocardiographic indices of left ventricular filling pressures in post-cardiac surgery patients (original) (raw)
B-Type Natriuretic Peptide (BNP) in Patients Undergoing Mitral Valve Surgery
Journal of Cardiac Surgery, 2008
Background and Aim: Plasma B-type natriuretic peptide (BNP) level may be increased in patients with valvular disease. Recent studies have suggested that in patients undergoing aortic valve replacement, an increased preoperative BNP is associated with a worse operative outcome. Little is known about the perioperative value of BNP in patients undergoing mitral valve (MV) surgery. We measured the preoperative and postoperative BNP levels in this population and analyzed the impact of the increased BNP level on surgical outcome. Methods: From March 2004 to February 2005, 42 patients (mean age 64 ± 12 years, 18 [42%] male) were enrolled in a prospective study. All patients underwent surgery for severe mitral regurgitation. The mean ejection fraction was 49 ± 13%, and 26 (62%) patients presented with atrial fibrillation (AF). Results: The median preoperative and postoperative BNP levels were 108 (9.7 to 995) and 357 (143 to 904) pg/mL, respectively (p = 0.002). Heart failure (p = 0.03), atrial fibrillation (AF) (p = 0.01), and ejection fraction (p = 0.01) were associated with an increased preoperative BNP level. In a multivariate analysis, the only independent predictor of the increased BNP level was AF (p = 0.01). In a univariate analysis, the preoperative BNP level was a significant predictor for inotropic support (p < 0.001), ventilation time (p = 0.003), intensive care unit (ICU; p = 0.01), and hospital length of stay (p = 0.02). In the multivariate analysis, BNP was not a predictor of these variables. Conclusions: Preoperative plasma BNP level presents with a high individual variability in patients with MV regurgitation. AF was the only independent predictor of an increased preoperative BNP level. The preoperative BNP level was not a predictor of surgical outcome. Further studies are required to confirm these findings and evaluate the potential role of this marker for patient selection.
B-type natriuretic peptide to assess haemodynamic status after cardiac surgery
British Journal of Anaesthesia, 2006
Background. B-type natriuretic peptide (BNP) is the most powerful hormonal marker of left ventricular dysfunction and could be considered as an indicator of ventricular preload. The aim of this prospective study was to compare the respective value of BNP and cardiac filling pressures to assess the response to volume load after cardiac surgery. Methods. Thirty-seven mechanically ventilated patients suffering from acute circulatory failure immediately after cardiac surgery, and equipped with a pulmonary-artery catheter were included. All haemodynamic measurements were taken before and after volume expansion using 500 ml of 4% modified fluid gelatin. Results. Fifteen patients were volume responders (CI increase>15%) and 22 were nonresponders. Right atrial pressure, pulmonary-artery occlusion pressure and BNP before volume loading were not significantly different between the responders and non-responders. BNP concentration before volume infusion significantly correlated to preoperative left ventricular ejection fraction, aortic cross-clamping time, serum creatinine, mean pulmonary arterial pressure and intensive care unit duration whereas no correlation was found with pulmonary-artery occlusion pressure or cardiac index. Conclusion. BNP level after cardiac surgery was influenced by many perioperative variables, limiting its usefulness as an indicator of cardiac preload or a predictor of volume responsiveness in this population.
Brain natriuretic peptide is a good predictor for outcome in cardiac surgery
Acta Anaesthesiologica Scandinavica, 2008
The heart secretes brain natriuretic peptide (BNP) in response to myocardial stretch. The aim of this study was to determine whether adverse effects after cardiac surgery were associated with higher serum BNP levels pre-operatively. One hundred and thirty-five patients undergoing various cardiac procedures were included in the study, and N-terminal pro-BNP (NT-pro-BNP) was measured pre-operatively. Post-operative complications were defined as follows: (i) a post-operative length of stay in the intensive care unit (ICU) exceeding 48 h; (ii) mortality at 28 days; (iii) the need for inotropic agents and/or intra-aortic balloon pump (IABP); and (iv) renal failure. Serum NT-pro-BNP values were compared for patients with and without complications. The serum NT-pro-BNP level was also correlated with the euroSCORE and ejection fraction (EF). Pre-operative serum NT-pro-BNP levels were significantly higher in patients with an ICU length of stay of more than 2 days or death prior to post-operative day 28 (3118 ng/l vs. 705 ng/l; P < 0.001). Pre-operative serum NT-pro-BNP levels were also significantly higher in patients needing inotropic agents (2628 ng/l vs. 548 ng/l; P < 0.001) or IABP insertion (3705 ng/l vs. 935 ng/l; P = 0.001) or developing renal failure (2857 ng/l vs. 945 ng/l; P < 0.001) post-operatively. The correlation between the serum NT-pro-BNP level and euroSCORE was good (r = 0.658; P < 0.001). The receiver operating characteristic (ROC) curves were used to assess the ability of serum NT-pro-BNP, euroSCORE and EF to predict outcome after cardiac surgery. This revealed an area under the ROC curve for the length of stay in the ICU or mortality at 28 days of 0.829 for serum NT-pro-BNP, 0.814 for euroSCORE and 0.328 for EF assessed by transesophageal echocardiography, indicating that the pre-operative serum NT-pro-BNP level is a good prognostic indicator for outcome after cardiac surgery. Serum NT-pro-BNP is a good predictor for complications after cardiac surgery, and is as good as euroSCORE and better than EF.
2001
Objective: The purpose of this study was to investigate the effectiveness of atrial and brain natriuretic peptides (ANP and BNP, respectively) as indicators of recovery of left ventricular (LV) function after coronary surgery. Methods: We measured the concentrations of these peptides in 31 patients with poor LV function (ejection fraction, EF , 35%) undergoing coronary artery bypass, and evaluated their correlation with the echocardiographic indexes of LV function. Results: Pre-operatively, the plasma levels of both ANP and BNP were markedly higher in coronary patients than in normal control subjects, and strongly correlated with both EF (BNP: r 20:8; P , 0:001; ANP: r 20:6; P , 0:001 and wall motion score index (WMSI). At post-operative follow up, plasma levels of both natriuretic peptides were markedly reduced compared with pre-operative values in 21 patients. In addition, the post-operative±pre-operative differences of BNP (D BNP ) and ANP (D ANP ) plasma levels strongly correlated with the differences of both EF r 20:7; P , 0:0001 vs. D BNP ; r 20:6; P 0:0003 vs. D ANP ) and WMSI r 0:6; P 0:002 vs. D BNP ; r 0:6; P 0:04 vs. D ANP ). Finally, by logistic regression analysis, BNP appeared a signi®cant predictor of LVEF recovery after surgery. Conclusion: Plasma levels of ANP and BNP might be used in routine clinical practice as a support to echocardiography in detecting recovery of the LV function after coronary surgery. q
Correlation to NT-ProBNP and Remodeling after Cardiac Surgery
Arquivos Brasileiros de Cardiologia, 2013
Background: Few data are available on diastolic function in patients with aortic stenosis (AOS) with indication of surgical treatment. A potential correlation between biomarkers and diastolic function has not been established. Objective: The aim of our study was to evaluate diastolic function in patients with AOS waiting for aortic valve replacement (AVR) echocardiographically, and to verify its correlation with serum brain natriuretic peptide (NT-proBNP). Methods: Thirty-one AOS patients (11 male), 21 to 81 years old (mean age, 61±15 years old) were studied before and after AVR. Diastolic function was assessed with Doppler methods: transvalvar mitral flow, tissue Doppler imaging (TDI) and pulmonary venous Doppler (PVD), correlating with serum brain natriuretic peptide (NT-proBNP) before and 6 months after AVR. Results: Comparing pre to post-operative period, we observed an increase of the left atrial ejection fraction and isovolumetric relaxation time (IRT), and the decrease of the mitral velocity to early diastolic velocity of the mitral annulus ratio (E/E'), the difference between the pulmonary A wave duration and mitral A duration, left atrial systolic volume, left atrial systolic volume index, left ventricular diastolic diameter, left ventricular systolic diameter, end diastolic volume (LVEDV), left ventricular mass index, left ventricular volume and mass index ratio. The values of NT-proBNP were positively correlated to diastolic dysfunction, both before and after surgery. Conclusion: AOS patients' ventricular diastolic function improved after AVR. The biomarker NT-proBNP might be a useful biomarker of diastolic function in these patients, before and after AVR. NT-proBNP values show a positive correlation with echocardiographic variables that determine diastolic dysfunction, and is a good marker for the characterization of this dysfunction in AOS patients. (Arq Bras Cardiol. 2013; [online].ahead print, PP.0-0
DOAJ (DOAJ: Directory of Open Access Journals), 2019
Background: Brain natriuretic peptide (BNP) is a cardiac hormone, which its levels as a marker of morbidity in patients undergoing coronary artery bypass grafting (CABG) is still controversial. This study aimed to investigate the relationship between the pre-and postoperative BNP changes and morbidity in adult patients undergoing CABG. Methods and materials: In this descriptive-analytical study, 50 patients were enrolled underwent elective CABG at the heart center of Rajaei hospital, Tehran, Iran, from September 2016 to May 2017. To determine the serum levels of BNP, blood samples were sent to laboratory at 24 hours before and 24 hours after induction of anesthesia. Duration of intubation, intensive care unit (ICU) stay, and ejection fraction and serum creatinine were considered. Data were analyzed with SPSS Version 22 software and significance level was 5%. Results: Of patients, 33 (66%) were male and 17 (34%) were female. The mean age ± SD of patients was 61±9 (range 36-82 years). Mean ± SD preoperative BNP level was 919.81±2264.22 pg/ml and postoperative BNP level was 2951.22±4291.27 pg/ml. A significant correlation between pre and postoperative BNP levels and the amount of creatinine, surgical time and length of stay in ICU was not observed. The ejection fraction was correlated with pre and postoperative BNP levels. Conclusion: Serum levels of BNP at 24 hours before and after cardiac surgery could be a good biomarker for prediction and early diagnosis of heart failure in adults.
Angiology, 2007
Objective: To evaluate the utility of plasma BNP measurement in the long term follow-up of patients with surgically repaired tetralogy of Fallot (TOF). Methods: From 2002 to 2008, plasma BNP concentration was measured in 130 patients with TOF at the age of mean 16.1 ± 7.1 years and mean 13.0 ± 6.5 years after surgically repair. BNP levels were compared to age and gender-specific normal values, results of exercise testing, clinical, electrocardiographic, and echocardiographic data. Results: BNP was b 200 pg/ml in all and elevated in 60% of patients. Higher values were found in females (p = 0.001), in patients waiting for pulmonary valve replacement (p b 0.001), and in NYHA class II compared to NYHA I patients (p = 0.012) with an inverse correlation between BNP and exercise time (r = − 0.59, p b 0.001). BNP was correlated with right ventricular dilatation (r = 0.29, p = 0.005) and severity of both tricuspid (r = 0.22, p = 0.015) and pulmonary regurgitation (r = 0.20, p = 0.029). Longitudinal data revealed increasing BNP levels before (p = 0.04) and a BNP decrease after pulmonary valve replacement (p = 0.03), but no change in patients without surgery. Conclusions: In patients with surgically repaired TOF, plasma BNP is significantly correlated with right ventricular volume load. In clinical practice a considerable overlap limits the estimation of right ventricular volume load by BNP, but longitudinal evaluation helps to appoint the appropriate timing of pulmonary valve replacement.
Circulation, 2004
(postop) atrial fibrillation (AF) occurs in up to 60% of patients after cardiac surgery, leading to longer hospital stays and increased healthcare costs. Recently, B-type natriuretic peptide (BNP) has been reported to predict occurrence of nonpostoperative AF. This study evaluates whether elevated preoperative (preop) plasma BNP levels predict the occurrence of postop AF. Methods and Results-One hundred eighty-seven patients with no history of atrial arrhythmia who had a preoperative BNP level and had undergone cardiac surgery were identified. Their records were reviewed, and postoperative ECG and telemetry strips were analyzed for AF until the time of discharge. Postop AF was documented in 80 patients (42.8%). AF patients were older (68Ϯ11 versus 64Ϯ14 years, Pϭ0.04), but there was no difference in sex distribution, hypertension, left ventricular (LV) function, LV hypertrophy (LVH), left atrial size, history of coronary artery disease (CAD), or -blocker use. Preop plasma BNP levels were higher in the postop AF patients (615 versus 444 pg/mL, Pϭ0.005). After adjustment for age, sex, type of surgery, hypertension, LV function, LVH, left atrial size, CAD, and -blocker use, the odds ratios of postop AF according to increasing quartiles, compared with patients with lowest quartile, were 1.8, 2.5, and 3.7 (P trend ϭ0.03). Conclusions-An elevated preop plasma BNP level is a strong and independent predictor of postop AF. This finding has important implications for identifying patients at higher risk of postop AF who could be considered for prophylactic antiarrhythmic or -blocker therapy. (Circulation. 2004;110:124-127.)
Journal of Interventional Cardiology, 2013
Objectives: We aimed to explore the relationship between brain natriuretic peptide (BNP) levels and right ventricular (RV) function in patients with mitral stenosis (MS), and to investigate the hemodynamic parameters that predict reduction of BNP levels after percutaneous mitral valvuloplasty (PMV). Background: Few studies have evaluated BNP in the context of MS, specifically the impact of the RV stroke work (RVSW) on serum BNP levels has not been defined. Methods: Thirty patients with symptomatic rheumatic MS in sinus rhythm who were referred for a PMV were enrolled. Right and left heart pressures were obtained before and after valvuloplasty. RVSW index (RVSWI) was calculated by cardiac catheterization. Results: Basal BNP levels were elevated in MS patients and correlated with several hemodynamic parameters including pulmonary pressure, pulmonary vascular resistance index, cardiac index (CI), and RVSWI. In multivariate analysis, CI and RVSWI were independent predictors of raised basal BNP levels. PMV resulted in a significant decrease in the RVSWI with a concurrent increase in CI (2.4 AE 0.43 to 2.9 AE 0.8 L/min/m 2 , P ¼ 0.010). Overall, plasma BNP levels significantly decreased from 124 (63/234) to 73 (48/148) pg/ml postvalvuloplasty. Multivariate analysis revealed that the reduction of left atrial (LA) pressure post-PMV was an independent predictor of change in BNP levels. Conclusions: Elevated baseline BNP level in MS patients was independently associated with CI and RVSWI. Plasma BNP levels were reduced after successful PMV, which was associated with the reduction of the LA pressure. (J Interven Cardiol 2013;9999:1-8) Ã Data are expressed as the mean value AE SD or median (interquartile range). † Mitral valve area was assessed by planimetry. ‡ Peak systolic myocardial velocity of the tricuspid annulus.