Top

Intensive Care Medicine

Published in:

01-09-2004 | Original

Increased plasma levels of pro-brain natriuretic peptide in patients with cardiovascular complications following off-pump coronary artery surgery

Authors: F. Kerbaul, F. Collart, R. Giorgi, C. Oddoze, P. J. Lejeune, C. Guidon, T. Caus, M. Bellezza, F. Gouin

Published in: Intensive Care Medicine | Issue 9/2004

Abstract

Objective

To compare N-terminal pro-brain natriuretic peptide (NT-pro-BNP), procalcitonin (PCT), and troponin I (Tn I) concentrations during and after coronary artery surgery in patients with or without cardiovascular complications.

Design and setting

Prospective, comparative study of 12 months in the cardiovascular intensive care unit in a university hospital

Patients

60 adult patients undergoing coronary artery bypass grafting with the off-pump technique.

Measurements and results

Plasma NT-pro-BNP, PCT, and Tn I levels were measured before and immediately after the end of operation and on PODs 1, and 2 and 3. We defined complicated postoperative course as myocardial infarction, cardiogenic shock, arrhythmias, congestive heart failure, and death occurring after the fourth postoperative hour. Receiver operating characteristic (ROC) curve cutoff values were used to assess the ability of the three markers to predict future cardiac events. The area under ROC curve (AUC) using NT-pro-BNP to detect a cardiovascular complicated course was 0.780 at the preoperative time and 0.850 at the end of surgery. A preoperative NT-pro-BNP value of 397 pg/ml had a sensitivity of 76%, specificity of 67%, and accuracy of 74% for predicting a subsequent cardiovascular complication. An immediate postoperative NT-pro-BNP value of 430 pg/ml had a sensitivity of 80%, specificity of 77%, and accuracy of 76%. Patients with preoperative NT-pro-BNP levels less than 275 pg/ml had an excellent postoperative prognosis. Other two markers were less appropriate.

Conclusions

NT-pro-BNP levels measured before and immediately after off-pump coronary artery bypass seem to be predictive of postoperative cardiac events.

Mehta Y, Juneja R (2002) Off-pump coronary artery bypass grafting: new developments but a better outcome? Curr Opin Anaesthesiol 15:9–18CrossRef

Demaria RG, Carrier M, Fortier S, Martineau R, Fortier A, Cartier R, Pellerin M, Hébert Y, Bouchard D, Pagé P, Perrault LP (2002) Reduced mortality and strokes with off-pump coronary artery bypass grafting surgery in octogenarians. Circulation 106:5–10PubMed

Lemos JA de, Morrow DA (2002) Brain natriuretic peptide in acute coronary syndromes. Ready for clinical application? Circulation 106:2868–2870CrossRefPubMed

Lemos JA de, Morrow DA, Bentley JH, Omland T, Sabatine MS, McCabe C, Hall C, Cannon CP, Braunwald E (2001) The prognostic value of B-type natriuretic peptide in patients with acute coronary syndromes. N Engl J Med 345:1014–1021CrossRefPubMed

Selvais PL, Donckier JE, Robert A, Laloux O, Linden F van, Ahn S, Ketelslegers JM, Rousseau MF (1998) Cardiac natriuretic peptides for diagnosis and risk stratification in heart failure: influence of left ventricular dysfunction and coronary artery diseases on cardiac hormonal activation. Eur J Clin Invest 28:636–642CrossRefPubMed

Wieczorek SJ, Wu AH, Christenson R, Krishnaswamy P, Gottlieb S, Rosano T, Hager D, Gardetto N, Chiu A, Bailly KR, Maisel A (2002) A rapid B-type natriuretic peptide assay accurately diagnoses left ventricular dysfunction and heart failure: a multicenter evaluation. Am Heart J 144:834–839CrossRefPubMed

Kerbaul F, Guidon C, Lejeune PJ, Mollo M, Mesana T, Gouin F (2002) Hyperprocalcitonemia is related to postoperative severe SIRS associated with cardiovascular dysfunction after coronary artery bypass graft surgery. J Cardiothorac Vasc Anesth 16:47–53CrossRefPubMed

Meisner M, Rauschmayer C, Schmidt J, Feyrer R, Cesnjevar R, Bredle D, Tschaikowsky K (2002) Early increase of procalcitonin after cardiovascular surgery in patients with postoperative complications. Intensive Care Med 28:1094–1102CrossRef

Lecharny JB, Khater D, Bronchard R, Philip I, Durand G, Desmonts JM, Dehoux M (2001) Hyperprocalcitonemia in patients with perioperative myocardial infarction after cardiac surgery. Crit Care Med 29:323–325PubMed

10.

Bertinchant JP, Laperche T, Polge A, Raczka F, Beyne P, Ledermann B, Himbert D, Pernel I, Nigond J, Cohen-Solal A (1997) Prognostic significance of early raised cardiac troponin I in unstable angina. Contribution to the identification of a high-risk sub-group. Arch Mal Coeur Vaiss 90:1615–1622PubMed

11.

Lasocki S, Provenchère S, Benessiano J, Vicaut E, Lecharny JB, Desmonts JM, Dehoux M, Philip I (2002) Cardiac troponin I is an independent predictor of in-hospital death after adult cardiac surgery. Anesthesiology 97:405–411CrossRefPubMed

12.

Joint European Society of Cardiology/American College of Cardiology Committee for the Redefinition of Myocardial Infarction (2000) Myocardial infarction redefined—a consensus document. Eur Heart J 21:1502–1513CrossRefPubMed

13.

Provenchère S, Plantefève G, Hufnagel G, Vicaut E, Vaumas C de, Lecharny JB, Depoix JP, Vrtovsnik F, Desmonts JM, Philip I (2003) Renal dysfunction after cardiac surgery with normothermic cardiopulmonary bypass: incidence, risk factors, and effect on clinical outcome. Anesth Analg 96:1258–1264PubMed

14.

Nashef SAM, Roques F, Michel P, Gauducheau E, Lemeshow S, Salamon R, the EuroSCORE study group (1999) European system for cardiac operative risk evaluation (EuroSCORE). Eur J Cardiothorac Surg 16:9–13CrossRefPubMed

15.

Parsonnet V, Dean D, Bernstein AD (1989) A method of uniform stratification of risk for evaluating the results of surgery in acquired adult heart disease. Circulation 79 (Suppl I):I3–I12PubMed

16.

Hanley JA, McNeil BJ (1983) A method of comparing the areas under receiving operating curves derived from the same cases. Radiology 148:839–843PubMed

17.

Yoshimura M, Yasue H, Okumura K, Ogawa H, Jougasaki M, Mukoyama M, Nakao K, Imura H (1993) Different secretion patterns of atrial natriuretic peptide and brain natriuretic peptide in patients with congestive heart failure. Circulation 87:464–469PubMed

18.

Clerico A, Lervasi G, Del Chicca MG, Emdin M, Maffei S, Nannipieri M, Sabatino L, Forini F, Manfredi C, Donato L (1998) Circulating levels of cardiac natriuretic peptides (ANP and BNP) measured by highly sensitive and specific immunoradiometric assays in normal subjects and in patients with different degrees of heart failure. J Endocrinol Invest 21:170–179PubMed

19.

Yamamoto K, Burnett JC, Jougasaki M, Nishimura MA, Bailey KR, Saito Y, Nakao K, Redfield MM (1996) The relative value of natriuretic peptides as markers for detecting abnormal ventricular structure and function. J Am Coll Cardiol 69A:721–723

20.

Choy AM, Darbar D, Lang CC, Pringle TH, McNeill GP, Kennedy NS, Struthers AD (1994) Detection of left ventricular dysfunction after acute myocardial infarction: comparison of clinical, echocardiographic, and neurohormonal methods. Br Heart J 72:16–22PubMed

21.

Lubien E, DeMaria A, Krishnaswamy P, Clopton P, Koon J, Kazanegra R, Gardetto N, Wanner E, Maisel AS (2002) Utility of B-natriuretic peptide in detecting diastolic dysfunction: comparison with Doppler velocity recordings. Circulation 5:595–601CrossRef

22.

Chello M, Mastroroberto P, Perticone F, Cirillo F, Bevacqua E, Olivito S, Covino E (2001) Plasma levels of atrial and brain natriuretic peptides as indicators of recovery of left ventricular systolic function after coronary artery bypass. Eur J Cardiothorac Surg 20:140–146CrossRefPubMed

23.

Nishikimi T, Futoo Y, Tamano K, Takahashi M, Suzuki T, Minami J, Honda T, Uetake S, Asakawa H, Kobayashi N, Horinaka S, Ishimitsu T, Matsuoka H (2001) Plasma brain natriuretic peptide levels in chronic hemodialysis patients: influence of coronary artery disease. Am J Kidney Dis 37:1201–1208PubMed

24.

Haug G, Metzele A, Steffgen J, Kochs M, Hombach V, Grunert A (1994) Increased brain natriuretic peptide and atrial natriuretic peptide plasma concentration in dialysis-dependent chronic renal failure and in patients with elevated left ventricular filling pressure. Clin Investig 72:430–434PubMed

25.

Nakao K, Mukoyama M, Hosoda K, Suga S, Ogawa Y, Saito Y, Shirakami G, Arai H, Jougasaki M, Imura H (1991) Biosynthesis, secretion, and receptor selectivity of human brain natriuretic peptide. Can J Physiol Pharmacol 69:1500–1506PubMed

Title: Increased plasma levels of pro-brain natriuretic peptide in patients with cardiovascular complications following off-pump coronary artery surgery
Authors: F. Kerbaul
F. Collart
R. Giorgi
C. Oddoze
P. J. Lejeune
C. Guidon
T. Caus
M. Bellezza
F. Gouin
Publication date: 01-09-2004
Publisher: Springer-Verlag
Published in: Intensive Care Medicine / Issue 9/2004
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-004-2299-0

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Increased plasma levels of pro-brain natriuretic peptide in patients with cardiovascular complications following off-pump coronary artery surgery

Abstract

Objective

Design and setting

Patients

Measurements and results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Objective

Design and setting

Patients

Measurements and results

Conclusions

Please log in to get access to this content

Other articles of this Issue 9/2004

Superior vena caval collapsibility as a gauge of volume status in ventilated septic patients

Patterns of colonization by Pseudomonas aeruginosa in intubated patients: a 3-year prospective study of 1,607 isolates using pulsed-field gel electrophoresis with implications for prevention of ventilator-associated pneumonia

The septic shock associated HSPA1B1267 polymorphism influences production of HSPA1A and HSPA1B

Pulmonary endothelium in acute lung injury: from basic science to the critically ill

A novel approach for selective brain cooling: implications for hypercapnia and seizure activity

The European Union Directive and the protection of incapacitated subjects in research: an ethical analysis