Abstract
Background: The existence of different degrees of inflammatory reaction and right ventricular dysfunction after pulmonary resection is well known, though its detection and clinical relevance have not been sufficiently evaluated. The introduction of new biomarkers, particularly brain natriuretic peptide (BNP) and its prohormone (proBNP), together with dynamic imaging techniques such as echocardiography, could prove useful in assessing such response. The aim of this study is to describe the kinetic curve of these biomarkers during uncomplicated pulmonary resection surgery. Furthemore we have studied the right ventricular function by echocardiography in these patients Methods: Demographic data, antecedents and certain perioperative parameters, as well as plasma proBNP, troponin T and C-reactive protein (CRP) levels, were recorded in 38 patients who underwent pneumonectomy (n= 13 ) and lobectomy (n=25), before and 24, 48 and 72 hours after the operation. A transthoracic echocardiogram was carried out preoperatively and 72 hours after surgery. Results: ProBNP showed a significant increase 24 hours after surgery, with a maximum peak after 72 hours (p<0.001). CRP likewise increased after 24 hours, with an inflammatory peak after 48 hours (p<0.001). The magnitude of the increase in proBNP and CRP was independent of the extent of resection (pneumonectomy versus lobectomy). Echocardiography showed a slight yet statistically significant decrease in right ventricular function (determined by tricuspid annular plane systolic excursion, TAPSE) in the pneumonectomy subgroup (p=0.01). Conclusion: The plasma proBNP elevation curve allows simple evaluation of the degree and time course of right ventricular dysfunction in the immediate postoperative period of uncomplicated pulmonary resection surgery. In stable patients, magnitude of proBNP elevation has no clinical repercussions, while slight echocardiographic changes are detectable only in pneumonectomized patients. Further studies are needed to evaluate the usefulness of abnormal proBNP elevations in predicting cardiorespiratory complications at patients bedside during the immediate postoperative period.
Highlights
It is well known that extensive pulmonary resections are related to a number of postoperative alterations in right ventricular function
The aim of this study is to describe the kinetic curve of these biomarkers during uncomplicated pulmonary resection surgery
Decrease of the pulmonary vascular bed area after such surgery implies an increase in pulmonary artery pressure (PAP), which can lead to an increase in right ventricular (RV) afterload
Summary
It is well known that extensive pulmonary resections are related to a number of postoperative alterations in right ventricular function. The recent introduction of new biological markers implicated in cardiorespiratory homeostasis, atrial natriuretic peptide (ANP), brain natriuretic peptide (BNP) and BNP prohormone (proBNP), and their increasingly widespread use in routine clinical practice, have served to establish their diagnostic, prognostic and monitoring usefulness in patients with heart failure [3] These peptides are synthesized by the myocardiocytes, and their production increases significantly in response to all factors that subject heart muscle to pressure and/or volume overload with subsequently increased ventricular. Conclusion: The plasma proBNP elevation curve allows simple evaluation of the degree and time course of right ventricular dysfunction in the immediate postoperative period of uncomplicated pulmonary resection surgery. Further studies are needed to evaluate the usefulness of abnormal proBNP elevations in predicting cardiorespiratory complications at patients bedside during the immediate postoperative period
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