Preoperative Plasma N-Terminal Pro-Brain Natriuretic Peptide Concentration and Perioperative Cardiovascular Risk in Elderly Patients

Abstract

t is very important to assess and predict risk in the cardiovascular system before noncardiac surgery. A number of cardiac indexes for predicting risk have been developed, and it is recommended to evaluate patients using these indexes and to institute preoperative medical treatment or coronary revascularization based on the results. [1][2][3][4] These clinical scoring systems, although simple to use, are somewhat inconvenient and have limitations in their predictive value, 2 whereas other cardiac investigations such as exercise or pharmacologic stress imaging are sensitive, but limited in practice by time and resources. 5 Recently brain natriuretic peptide (BNP) was spotlighted as a predictor for diagnosing and predicting the prognosis of various heart diseases. BNP is a cardiac hormone that is synthesized by ventricular myocytes in response to ventricuCirculation Journal Vol.72, February 2008 lar dysfunction and wall stress. 6 Recent studies have demonstrated that elevated serum BNP levels predict first cardiovascular event and death in the general population. 7,8 In addition, it has been reported that BNP measured before cardiac surgery can be used as a predictor of postoperative cardiac complications. 9 Thus we assumed that the preoperative N-terminal (NT)-proBNP concentration would also predict postoperative cardiovascular complications and prognosis in noncardiac and nonvascular surgery, so in the present study we compared the revised cardiac index, the preoperative BNP concentration and postoperative complications in elderly patients aged over 60 years in whom the risk of postoperative complications was relatively high. Methods Study PopulationWe prospectively analyzed patients aged over 60 years who had been admitted to Wonkwang University Hospital for noncardiac and nonvascular operation under general anesthesia during the period from January to December 2006. We excluded patients who had an emergency operation, those who had left ventricular (LV) dysfunction (ejection fraction <50%), those who were receiving hemodialysis or peritoneal dialysis for renal failure, and those who had a J 2008; 72: 195 -199 (Received September 6, 2007; revised manuscript received October 17, 2007; accepted October 22, 2007 Background The prediction of perioperative cardiovascular complications is important in the medical management of patients undergoing noncardiac surgery. Several indices have been developed, but a simpler, more practical and accurate method is needed. The purpose of this study was to determine whether the N-terminal probrain natriuretic peptide (NT-proBNP) concentration before operation can be used to predict perioperative cardiovascular complications in elderly patients undergoing noncardiac surgery. Circ Methods and ResultsThe study group comprised 279 patients older than 60 years who were scheduled for elective surgery. The plasma NT-proBNP concentration, clinical cardiac indices and left ventricular ejection fraction were measured prior to operation. The postoperative cardiac outcomes were follow...

Preoperative B-type natriuretic peptides in patients undergoing noncardiac surgery: a cumulative meta-analysis

“…In total, 24 of the 28 studies 29,[34][35][36][37][38][40][41][42][43][46][47][48][49][50][51][52][53][55][56][57][58][59][60] were prospective observational cohort studies. Of the remaining four studies: …”

“…Of the remaining studies, three reported exclusively on patients undergoing emergency surgery, 38,45,48 and one documented both elective and emergency surgeries that were classified as being high risk. 46 Certain studies investigated outcomes in a specific surgical discipline, including thoracic surgery (4), 36,50,51,54 vascular (7), 29,40,42,44,55,57,59 orthopaedic (5), 45,[47][48][49]60 major abdominal (1), 56 oesophagectomy (1), 41 while the rest documented outcomes following a variety of surgeries performed (10), 34,35,[37][38][39]43,46,52,53,58 including a mix of general, head and neck, gynaecological, orthopaedic, vascular, urological, neurosurgery and thoracic surgery.…”

II Diretriz de Avaliação Perioperatória da Sociedade Brasileira de Cardiologia

“…In recent years, several studies [59][60][61][62][63] in the literature have shown that the measurement of BNP or NT-proBNP levels in the preoperative period may help identify patients at risk for cardiovascular complications and postoperative cardiovascular events. Observational studies have suggested that high BNP or NT-proBNP levels in the preoperative period are independent predictors of perioperative cardiovascular complications in noncardiac surgeries.…”

Predictors of Cardiac Complications of Abdominal and Small Pelvic Surgery in Elderly and Senile Patients

“…По данным не давнего метаанализа, эти биомаркеры являются неза висимыми предикторами периоперационных карди альных осложнений во внесердечной хирургии [6]. В качестве порогового уровня авторы используют кон центрации NT proBNP от 201 до 601 пг/мл [7][8][9][10][11].…”

“…По результатам небольших исследований, разброс порогового уровня NT proBNP велик -от 201 до 601 пг/мл [7][8][9][10][11]. Для его уточнения необходимы крупномасштабные много центровые исследования с участием тысяч пациентов -по всей видимости, дело будущего.…”