17 Aug 07

Utility of B-type natriuretic peptide in predicting perioperative cardiac events in patients undergoing major non-cardiac surgery

Posted in Anesthesia, BNP, Heart failure/Cardiogenic shock, Pre-operatie evaluation at 20:23 by Laci

By B. H. Cuthbertson, A. R. Amiri, B. L. Croal, S. Rajagopalan, O. Alozairi, J. Brittenden and G. S. Hillis

British Journal of Anaesthesia 2007;99:170-176

B-type natriuretic peptide (BNP) levels predict cardiovascular risk in several settings. We hypothesized that they would identify individuals at increased risk of early cardiac complications after major non-cardiac surgery. The current study tests this hypothesis.

Methods
Two hundred and four patients undergoing major non-cardiac surgery were studied. The primary end-point was the development of acute myocardial injury [defined as cardiac troponin I (cTnI) level > 0.32 ng ml–1] or death in the 3 days after surgery.

Results
Preoperative BNP levels were raised in patients who died or suffered perioperative myocardial injury (median 52.2 vs 22.2 pg ml–1, P = 0.01) and BNP predicted this outcome with an area under the receiver operating characteristic curve of 0.72 [95% confidence interval (CI) 0.59–0.86, P = 0.01]. A preoperative BNP value > 40 pg ml–1 was associated with an increased risk of death or perioperative myocardial injury [odds ratio (OR) 6.8, 95% CI 1.8–25.9, P = 0.003], and remained independently predictive after correction for the Revised Cardiac Risk Index. Preoperative BNP levels were higher in patients who exhibited new onset atrial fibrillation or ST/T-wave changes on their postoperative ECG (median 50.5 vs 22.5 pg litre–1, P = 0.01). They were also higher in patients who had either elevation of cTnI > 0.32 ng ml–1 or postoperative ECG abnormalities (median 50.4 vs 21.5 pg ml–1, P < 0.001).

Conclusions
In the setting of major non-cardiac surgery, preoperative BNP levels are higher in patients who experience perioperative death and myocardial injury. Larger studies are required to confirm these data and to clarify what BNP levels may add to existing methods of risk stratification.

Preoperative plasma BNP concentrations: do they improve our care of high-risk non-cardiac surgical patients

Posted in Anesthesia, BNP, Heart failure/Cardiogenic shock at 20:22 by Laci

By J. W. Sear and G. Howard-Alpe

British Journal of Anaesthesia 2007;99:151-154

There is presently much interest in the preoperative identification of high-risk patients undergoing major surgery—with the aim of adopting management strategies which may reduce postoperative morbidity and mortality. In the non-cardiac surgical patient, data for the UK suggest that there may be up to 8000 cardiovascular deaths per year for 5 million surgical procedures performed, with an incidence of 10 times that with regard to morbidity (myocardial infarction, congestive cardiac failure, malignant arrhythmias, and cardiac arrest). The major pathological disorder responsible for these adverse outcomes is ischaemic heart disease, either overt or covert, secondary to atherosclerosis. We, and others, have recently reviewed the role of biomarkers in the identification of at-risk cardiac patients.

For a test to be useful as a biomarker, it should to be able to differentiate between the ‘healthy’ and the ‘compromised’ patient. In epidemiological terms, it needs to have a high sensitivity (probability that the biomarker….

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