NT-Pro BNP Predicts Myocardial Injury Post-vascular Surgery and is Reduced with CoQ10: A Randomized Double-Blind Trial

Khan, Asrar; Johnson, Debra K.; Carlson, Selma; Hocum-Stone, Laura; Kelly, Rosemary F.; Gravely, Amy; Mbai, Mackenzi; Green, Derrick L.; Santilli, Steve; García, Santiago; Adabag, Selçuk; McFalls, Edward O.

doi:10.1016/j.avsg.2019.09.017

Cited by 21 publications

(28 citation statements)

References 51 publications

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“…In preoperative risk stratification, biomarkers are gaining more and more importance. Brain natriuretic peptide (BNP) or its N-terminal prohormone, for example, were shown to be validly associated with the incidence of myocardial injury, as well as with major adverse cardiac events after non-cardiac surgery [ 23 , 24 ]. Therefore, preoperative BNP assessment for perioperative cardiac risk stratification is recommended by recent national guidelines [ 25 , 26 ].…”

Section: Discussionmentioning

confidence: 99%

Perioperative Vascular Biomarker Profiling in Elective Surgery Patients Developing Postoperative Delirium: A Prospective Cohort Study

et al. 2021

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Background: Postoperative delirium (POD) ranks among the most common complications in surgical patients. Blood-based biomarkers might help identify the patient at risk. This study aimed to assess how serum biomarkers with specificity for vascular and endothelial function and for inflammation are altered, prior to or following surgery in patients who subsequently develop POD. Methods: This was a study on a subcohort of consecutively recruited elective non-cardiac as well as cardiac surgery patients (age > 60 years) of the single-center PROPDESC trial at a German tertiary care hospital. Serum was sampled prior to and following surgery, and the samples were subjected to bead-based multiplex analysis of 17 serum proteins (IL-3, IL-8, IL-10, Cripto, CCL2, RAGE, Resistin, ANGPT2, TIE2, Thrombomodulin, Syndecan-1, E-Selectin, VCAM-1, ICAM-1, CXCL5, NSE, and uPAR). Development of POD was assessed during the first five days after surgery, using the Confusion Assessment Method for ICU (CAM-ICU), the CAM, the 4-’A’s test (4AT), and the Delirium Observation Scale (DOS). Patients were considered positive if POD was detected at least once during the visitation period by any of the applied methods. Non-parametric testing, as well as propensity score matching were used for statistical analysis. Results: A total of 118 patients were included in the final analysis; 69% underwent non-cardiac surgery, median overall patient age was 71 years, and 59% of patients were male. In the whole cohort, incidence of POD was 28%. The male gender was significantly associated with the development of POD (p = 0.0004), as well as a higher ASA status III (p = 0.04). Incidence of POD was furthermore significantly increased in cardiac surgery patients (p = 0.002). Surgery induced highly significant changes in serum levels of almost all biomarkers except uPAR. In preoperative serum samples, none of the analyzed parameters was significantly altered in subsequent POD patients. In postoperative samples, CCL2 was significantly increased by a factor of 1.75 in POD patients (p = 0.03), as compared to the no-POD cohort. Following propensity score matching, CCL2 remained the only biomarker that showed significant differences in postoperative values (p = 0.01). In cardiac surgery patients, postoperative CCL2 serum levels were more than 3.5 times higher than those following non-cardiac surgery (p < 0.0001). Moreover, after cardiac surgery, Syndecan-1 serum levels were significantly increased in POD patients, as compared to no-POD cardiac surgery patients (p = 0.04). Conclusion: In a mixed cohort of elective non-cardiac as well as cardiac surgery patients, preoperative serum biomarker profiling with specificity for vascular dysfunction and for systemic inflammation was not indicative of subsequent POD development. Surgery-induced systemic inflammation—as evidenced by the significant increase in CCL2 release—was associated with POD, particularly following cardiac surgery. In those patients, postoperative glycocalyx injury might furthermore contribute to POD development.

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Section: Discussionmentioning

confidence: 99%

Perioperative Vascular Biomarker Profiling in Elective Surgery Patients Developing Postoperative Delirium: A Prospective Cohort Study

et al. 2021

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“…Preoperative NT Pro-BNP has been recommended as an optimal means of risk-stratifying patients undergoing non-cardiac operations (11) and has been shown to have value in patients undergoing vascular surgery (12). In support of those studies, we have shown that preoperative NT pro-BNP levels predict postoperative risk of myocardial injury and of interest, can be reduced following surgery with preoperative administration of ubiquinone (CoQ 10 ) (13). C-reactive protein, a readily available biomarker can also predict poor outcomes in patients with ischemic heart disease (14,15) and together with BNP, may have value in predicting adverse events in patients with vascular disease (16,17).…”

Section: Introductionmentioning

confidence: 88%

“…The methodology of the primary trial results has been previously published (13) and is summarized in Figure 1. Following informed consent, patients were referred to a research pharmacist and treatment was randomly designated in a blinded fashion, with permuted blocks.…”

Section: Randomization and Assignment Of Treatmentmentioning

confidence: 99%

Preoperative C-Reactive Protein Levels Predict Readmission Following Elective Vascular Surgery

McFalls¹,

Khan²,

Dl³

et al. 2021

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BackgroundC-reactive protein levels (CRP) may be reduced with long-term administration of ubiquinol (CoQ10) in patients with chronic ischemic heart disease but the impact of a short-term period of administration in patients undergoing elective vascular surgery is uncertain.MethodsA double-blind randomized controlled trial was implemented to determine whether preoperative administration of CoQ10 could reduce cardiac biomarker elevations. Patients were randomly assigned to CoQ10 (400 mg per day) versus Placebo for 3 days prior to surgery. BNP, troponin and CRP were obtained pre and post-surgery. The primary endpoint was peak BNP and secondary endpoints were length of stay and readmission.ResultsOne hundred and twenty-three patients were randomly assigned to CoQ10 (N=62) or Placebo (N=61) for 3 days pre-surgery. At 24 hours post-surgery, the group receiving CoQ10 had lower BNP levels with no intergroup differences in CRP. Within 1-year post-discharge, thirty-six (29%) were readmitted and preoperative risk for readmission (HR: 95% CI) included diabetes mellitus (3.60: 1.46-8.91), active smoking (3.55: 1.43-8.78) and CRP (1.35: 1.04-1.76). C-index for all three variables predicting readmission was 0.727. ConclusionsShort-term administration of CoQ10 reduced perioperative BNP but not CRP levels. CRP, along with diabetes and active smoking were independent predictors of readmission and should be targeted as a means of reducing subsequent rehospitalizations following elective vascular procedures.Trial Registrationclinicaltrials.gov Identifier: NCT03956017

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“…NT-proBNP levels predict adverse post-vascular surgery events. It has been demonstrated that preoperative administration of CoQ10 for 3 days prior to the elective vascular surgical procedure lowers perioperative NT-proBNP levels [ 30 , 76 ].…”

Section: Coq10 In Cardiac Surgery and Coronary Arterial Disease (Cad)mentioning

confidence: 99%

The Use of Coenzyme Q10 in Cardiovascular Diseases

Llanos-González

Alcaı́n

2021

Antioxidants

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CoQ10 is an endogenous antioxidant produced in all cells that plays an essential role in energy metabolism and antioxidant protection. CoQ10 distribution is not uniform among different organs, and the highest concentration is observed in the heart, though its levels decrease with age. Advanced age is the major risk factor for cardiovascular disease and endothelial dysfunction triggered by oxidative stress that impairs mitochondrial bioenergetic and reduces NO bioavailability, thus affecting vasodilatation. The rationale of the use of CoQ10 in cardiovascular diseases is that the loss of contractile function due to an energy depletion status in the mitochondria and reduced levels of NO for vasodilatation has been associated with low endogenous CoQ10 levels. Clinical evidence shows that CoQ10 supplementation for prolonged periods is safe, well-tolerated and significantly increases the concentration of CoQ10 in plasma up to 3–5 µg/mL. CoQ10 supplementation reduces oxidative stress and mortality from cardiovascular causes and improves clinical outcome in patients undergoing coronary artery bypass graft surgery, prevents the accumulation of oxLDL in arteries, decreases vascular stiffness and hypertension, improves endothelial dysfunction by reducing the source of ROS in the vascular system and increases the NO levels for vasodilation.

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NT-Pro BNP Predicts Myocardial Injury Post-vascular Surgery and is Reduced with CoQ10: A Randomized Double-Blind Trial

Cited by 21 publications

References 51 publications

Perioperative Vascular Biomarker Profiling in Elective Surgery Patients Developing Postoperative Delirium: A Prospective Cohort Study

Perioperative Vascular Biomarker Profiling in Elective Surgery Patients Developing Postoperative Delirium: A Prospective Cohort Study

Preoperative C-Reactive Protein Levels Predict Readmission Following Elective Vascular Surgery

The Use of Coenzyme Q10 in Cardiovascular Diseases

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