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Preoperative Brain Natriuretic Peptide (BNP) Is a Better Predictor of Adverse Cardiac Events Compared to Preoperative Scoring System in Patients Who Underwent Abdominal Surgery

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Abstract

Background

Cardiovascular disease is the leading cause of perioperative death in surgical patients. A variety of clinical scoring systems have been developed to predict adverse cardiovascular events. B-type natriuretic peptide (BNP) is a sensitive and specific predictor of left ventricular systolic dysfunction and predicts first cardiovascular event and death in the general population. We present a prospective, single-center, observational cohort study of patients undergoing major abdominal surgery and evaluate the role of BNP in predicting adverse cardiac events.

Method

A total of 205 patients were included in the study. All patients were assessed by a cardiological clinical evaluation, a 12-lead ECG report, and a preoperative and postoperative blood sample for plasmatic BNP assessment. The primary end point was the predictive power of preoperative BNP levels for adverse cardiac events until 30 days after discharge.

Results

Thirty-one of 205 (15%) patients had adverse cardiac events in the postoperative period up to 30 days after discharge. Five patients (2.4%) of these died of cardiac events. Preoperative BNP values were significantly increased in the 31 patients compared to the other patients in the postoperative period [mean = 112.93 pg/ml (range = 5–2,080) vs. 178.99 pg/ml (range = 5–3,980); median = 117 vs. 23 pg/ml; 95% CI = 49–181; p < 0.0001]. At logistic regression, a preoperative BNP value of >36 pg/ml was the only effective predictor of adverse cardiac events.

Conclusion

We have demonstrated that elevated preoperative BNP levels are independent predictors of adverse cardiac events in a cohort of patients undergoing major abdominal surgery in a general surgery department, and this is the first study about this specific cohort of patients.

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References

  1. Goldman L et al (1977) Multifactorial index of cardiac risk in noncardiac surgical procedures. N Engl J Med 297(16):845–850

    Article  PubMed  CAS  Google Scholar 

  2. Lee TH et al (1999) Derivation and prospective validation of a simple index for prediction of cardiac risk of major noncardiac surgery. Circulation 100(10):1043–1049

    PubMed  CAS  Google Scholar 

  3. Fleischmann KE et al (2003) Association between cardiac and noncardiac complications in patients undergoing noncardiac surgery: outcomes and effects on length of stay. Am J Med 115(7):515–520

    Article  PubMed  Google Scholar 

  4. Lee TH et al (1999) Derivation and prospective validation of a simple index for prediction of cardiac risk of major noncardiac surgery. Circulation 100(10):1043–1049

    PubMed  CAS  Google Scholar 

  5. Jin F, Chung F (2001) Minimizing perioperative adverse events in the elderly. Br J Anaesth 87(4):608–624

    Article  PubMed  CAS  Google Scholar 

  6. Mangano DT (1990) Perioperative cardiac morbidity. Anesthesiology 72(1):153–184

    Article  PubMed  CAS  Google Scholar 

  7. Mangano DT et al (1990) Association of perioperative myocardial ischemia with cardiac morbidity and mortality in men undergoing noncardiac surgery. The Study of Perioperative Ischemia Research Group. N Engl J Med 323(26):1781–1788

    Article  PubMed  CAS  Google Scholar 

  8. Mangano DT, Goldman L (1995) Preoperative assessment of patients with known or suspected coronary disease. N Engl J Med 333(26):1750–1756

    Article  PubMed  CAS  Google Scholar 

  9. Brian CA et al (1999) Pulmonary arteriovenous malformation. Circulation 100(4):e29–e30

    PubMed  CAS  Google Scholar 

  10. Detrano R et al (1989) Exercise-induced ST segment depression in the diagnosis of multivessel coronary disease: a meta analysis. J Am Coll Cardiol 14(6):1501–1508

    Article  PubMed  CAS  Google Scholar 

  11. Shaw LJ et al (1996) Meta-analysis of intravenous dipyridamole-thallium-201 imaging (1985 to 1994) and dobutamine echocardiography (1991 to 1994) for risk stratification before vascular surgery. J Am Coll Cardiol 27(4):787–798

    Article  PubMed  CAS  Google Scholar 

  12. Poldermans D et al (1993) Dobutamine stress echocardiography for assessment of perioperative cardiac risk in patients undergoing major vascular surgery. Circulation 87(5):1506–1512

    PubMed  CAS  Google Scholar 

  13. Landesberg G et al (1997) Perioperative ischemia and cardiac complications in major vascular surgery: importance of the preoperative twelve-lead electrocardiogram. J Vasc Surg 26(4):570–578

    Article  PubMed  CAS  Google Scholar 

  14. Hundley WG et al (1999) Utility of fast cine magnetic resonance imaging and display for the detection of myocardial ischemia in patients not well suited for second harmonic stress echocardiography. Circulation 100(16):1697–1702

    PubMed  CAS  Google Scholar 

  15. Nagel E et al (1999) Noninvasive diagnosis of ischemia-induced wall motion abnormalities with the use of high-dose dobutamine stress MRI: comparison with dobutamine stress echocardiography. Circulation 99(6):763–770

    PubMed  CAS  Google Scholar 

  16. Paetsch I et al (2004) Comparison of dobutamine stress magnetic resonance, adenosine stress magnetic resonance, and adenosine stress magnetic resonance perfusion. Circulation 110(7):835–842

    Article  PubMed  CAS  Google Scholar 

  17. Rerkpattanapipat P et al (2002) Assessment of preoperative cardiac risk with magnetic resonance imaging. Am J Cardiol 90(4):416–419

    Article  PubMed  Google Scholar 

  18. Beattie WS et al (2006) A meta-analytic comparison of preoperative stress echocardiography and nuclear scintigraphy imaging. Anesth Analg 102(1):8–16

    Article  PubMed  Google Scholar 

  19. Levin ER, Gardner DG, Samson WK (1998) Natriuretic peptides. N Engl J Med 339(5):321–328

    Article  PubMed  CAS  Google Scholar 

  20. Fonarow GC et al (2007) Admission B-type natriuretic peptide levels and in-hospital mortality in acute decompensated heart failure. J Am Coll Cardiol 49(19):1943–1950

    Article  PubMed  CAS  Google Scholar 

  21. Maisel AS et al (2002) Rapid measurement of B-type natriuretic peptide in the emergency diagnosis of heart failure. N Engl J Med 347(3):161–167

    Article  PubMed  CAS  Google Scholar 

  22. McDonagh TA et al (2004) NT-proBNP and the diagnosis of heart failure: a pooled analysis of three European epidemiological studies. Eur J Heart Fail 6(3):269–273

    Article  PubMed  CAS  Google Scholar 

  23. Wang TJ et al (2004) Plasma natriuretic peptide levels and the risk of cardiovascular events and death. N Engl J Med 350(7):655–663

    Article  PubMed  CAS  Google Scholar 

  24. Cuthbertson BH et al (2007) Utility of B-type natriuretic peptide in predicting perioperative cardiac events in patients undergoing major non-cardiac surgery. Br J Anaesth 99(2):170–176

    Article  PubMed  CAS  Google Scholar 

  25. Cuthbertson BH et al (2007) Utility of B-type natriuretic peptide in predicting medium-term mortality in patients undergoing major non-cardiac surgery. Am J Cardiol 100(8):1310–1313

    Article  PubMed  CAS  Google Scholar 

  26. Berry C et al (2006) Predictive value of plasma brain natriuretic peptide for cardiac outcome after vascular surgery. Heart 92(3):401–402

    Article  PubMed  CAS  Google Scholar 

  27. Feringa HH et al (2006) Association of plasma N-terminal pro-B-type natriuretic peptide with postoperative cardiac events in patients undergoing surgery for abdominal aortic aneurysm or leg bypass. Am J Cardiol 98(1):111–155

    Article  PubMed  CAS  Google Scholar 

  28. Nojiri T et al (2010) Predictive value of B-type natriuretic peptide for postoperative atrial fibrillation following pulmonary resection for lung cancer. Eur J Cardiothorac Surg 37(4):787–791

    Article  PubMed  Google Scholar 

  29. Dickstein K et al (2008) ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2008: the Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2008 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association of the ESC (HFA) and endorsed by the European Society of Intensive Care Medicine (ESICM). Eur Heart J 29(19):2388–2442

    Article  PubMed  CAS  Google Scholar 

  30. Gilbert K, Larocque BJ, Patrick LT (2000) Prospective evaluation of cardiac risk indices for patients undergoing noncardiac surgery. Ann Intern Med 133(5):356–359

    PubMed  CAS  Google Scholar 

  31. Swets JA (1988) Measuring the accuracy of diagnostic systems. Science 240(4857):1285–1293

    Article  PubMed  CAS  Google Scholar 

  32. Ford MK, Beattie WS, Wijeysundera DN (2010) Systematic review: prediction of perioperative cardiac complications and mortality by the revised cardiac risk index. Ann Intern Med 152(1):26–35

    PubMed  Google Scholar 

  33. Eagle KA et al (2002) ACC/AHA Guideline Update for Perioperative Cardiovascular Evaluation for Noncardiac Surgery–Executive Summary. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1996 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery). Circulation 105(10):1257–1267

    PubMed  Google Scholar 

  34. American College of Physicians (1997) Guidelines for assessing and managing the perioperative risk from coronary artery disease associated with major noncardiac surgery. Ann Intern Med 127(4):309–312

    Google Scholar 

  35. Fox AA et al (2008) Preoperative B-type natriuretic peptide is as independent predictor of ventricular dysfunction and mortality after primary coronary artery bypass grafting. J Thorac Cardiovasc Surg 136(2):452–461

    Article  PubMed  CAS  Google Scholar 

  36. Goei D et al (2009) The interrelationship between preoperative anemia and N-terminal pro-B-type natriuretic peptide: the effect on predicting postoperative cardiac outcome in vascular surgery patients. Anesth Analg 109(5):1403–1408

    Article  PubMed  CAS  Google Scholar 

  37. Rodseth RN, Padayachee L, Biccard BM (2008) A meta-analysis of the utility of pre-operative brain natriuretic peptide in predicting early and intermediate-term mortality and major adverse cardiac events in vascular surgical patients. Anaesthesia 63(11):1226–1233

    Article  PubMed  CAS  Google Scholar 

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Disclosure

The authors certify that they do not have any commercial associations (e.g., consultancies, stock ownership, equity interests, patent-licensing arrangements, research support, speaker’s bureau) that might pose a conflict of interest in connection with the article.

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Authors and Affiliations

  1. Department of Surgery, University of Rome “La Sapienza”, II° Faculty of Medicine and Surgery, Azienda Ospedaliera Sant’Andrea, Via di Grottarossa, 1035-39, 00189, Rome, Italy

    Paolo Mercantini, Andrea Kazemi Nava, Andrea Scarinci, Marco La Torre, Mario Ferri, Niccolò Petrucciani & Vincenzo Ziparo

  2. Emergency Department, University of Rome “La Sapienza”, II° Faculty of Medicine and Surgery, Azienda Ospedaliera Sant’Andrea, Via di Grottarossa, 1035-39, 00189, Rome, Italy

    Salvatore Di Somma, Laura Magrini & Enrico Ferri

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  1. Paolo Mercantini
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  2. Salvatore Di Somma
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  3. Laura Magrini
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Correspondence to Paolo Mercantini.

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Mercantini, P., Di Somma, S., Magrini, L. et al. Preoperative Brain Natriuretic Peptide (BNP) Is a Better Predictor of Adverse Cardiac Events Compared to Preoperative Scoring System in Patients Who Underwent Abdominal Surgery. World J Surg 36, 24–30 (2012). https://doi.org/10.1007/s00268-011-1354-6

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  • DOI: https://doi.org/10.1007/s00268-011-1354-6

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