The Role of BNP and CRP in Predicting the Development of Atrial Fibrillation in Patients Undergoing Isolated Coronary Artery Bypass Surgery

Abstract

Objective. To evaluate the association of BNP and CRP with the development of postoperative atrial fibrillation following coronary artery bypass grafting surgery. Methods. The series consists of 125 patients (aged 65 ± 9 years), who underwent isolated CABG-surgery. BNP and CRP levels were measured pre- and 24 hours postoperatively and their correlation to the development of postoperative AF was analyzed. Results. Forty-four patients (35%) developed AF postoperatively. They were significantly older (68 ± 8 versus 63 ± 9, P = 0.01) and predominantly nonsmokers (18% versus 46%, P = 0.004), compared to the non-AF cases. In addition they showed significant higher preoperative mean BNP levels of 629 versus 373 pg/mL (P = 0.019). Postoperative BNP levels were significantly higher in both groups (AF-group: 1032 pg/mL versus non-AF group: 705 pg/mL; P < 0.001), while there was a trend of more increased postoperative levels in AF-cases (P = 0.065). AF-episodes appeared significantly more frequent in the two highest quartiles of BNP levels with 44% (P = 0.035). On the contrary pre- and postoperative CRP levels were not associated with AF. Multivariable analysis revealed only increased preoperative BNP levels as independent predictor for postoperative AF (P = 0.036). Conclusion. Elevated preoperative BNP serum levels are associated with the development of post-CABG AF, while CRP does not seem to be influential.

Liver enzymes are not directly involved in atrial fibrillation: a prospective cohort study

“…Heart failure and AF often coincide with causal pathways in both directions . This is at least partly supported by our results confirming the known relationship between NT‐proBNP and AF (OR, 1·53; 95% CI, 1·24–1·88; P < 0·0001) in fully adjusted models which also included ∆GGT and ∆total bilirubin. On balance, the link between the failing heart and the liver described above also seems evident with the disappearance of the association between AF and GGT after adjusting for ∆total bilirubin as both GGT and bilirubin are elevated in congestive hepatopathy .…”

De novo atrial fibrillation post cardiac surgery : the Durban experience : cardiovascular topic

“…Studies by Gasparovic et al and Pilatis et al showed elevated B-type natriuretic peptide (BNP) levels to be predictive of AF in patients undergoing CABG. 28 , 29 The utility of biomarkers in the setting of AF post cardiac surgery requires further clarification prior to a recommendation on their use but preliminary studies certainly show promise for AF prediction and thromboembolic risk stratification.…”

Association between incidence of atrial fibrillation and duration of cardiopulmonary bypass in coronary artery bypass graft surgery (CABG): a cohort study

“…Numerous studies, mainly retrospective, have been conducted to clarify the pathogenesis of postoperative AF as well as to identify predisposing factors. However, the exact etiologic pattern still remains unclear ( 22 ). The proposed contributory factors include inflammation triggered by cardiopulmonary bypass, beta-blocker withdrawal, hyperthyroidism, caffeine, right coronary artery stenosis, atrial ischemia, inadequate intraoperative cardiac protection, perioperative ischemic injury, postoperative pericarditis, autonomic imbalance, and fluid/electrolyte disturbances during the intra-and post operative periods ( 22 , 23 ).…”

“…However, the exact etiologic pattern still remains unclear ( 22 ). The proposed contributory factors include inflammation triggered by cardiopulmonary bypass, beta-blocker withdrawal, hyperthyroidism, caffeine, right coronary artery stenosis, atrial ischemia, inadequate intraoperative cardiac protection, perioperative ischemic injury, postoperative pericarditis, autonomic imbalance, and fluid/electrolyte disturbances during the intra-and post operative periods ( 22 , 23 ). It is assumed that one of the reasons of POAF may be the post-operative local and systemic inflammations ( 24 ).…”