Abstract
BackgroundPostoperative heart failure (PHF) is the main cause for mortality after cardiac surgery but unbiased evaluation of PHF is difficult. We investigated the utility of postoperative NT-proBNP as an objective marker of PHF after coronary artery bypass surgery (CABG).MethodsProspective study on 382 patients undergoing isolated CABG for acute coronary syndrome. NT-proBNP was measured preoperatively, the first (POD1) and third postoperative morning (POD3). A blinded Endpoints Committee used prespecified criteria for PHF. Use of circulatory support was scrutinized.ResultsAfter adjusting for confounders PHF was associated with 1.46 times higher NT-proBNP on POD1 (p = 0.002), 1.54 times higher on POD3 (p < 0.0001). In severe PHF, NT-proBNP was 2.18 times higher on POD1 (p = 0.001) and 1.81 times higher on POD3 (p = 0.019). Postoperative change of NT-proBNP was independently associated with PHF (OR 5.12, 95% CI 1.86–14.10, p = 0.002). The use of inotropes and ICU resources increased with incremental quartiles of postoperative NT-proBNP.ConclusionsPostoperative NT-proBNP can serve as an objective marker of the severity of postoperative myocardial dysfunction. Due to overlap in individuals, NT-proBNP is useful mainly for comparisons at cohort level. As such, it provides a tool for study purposes when an unbiased assessment of prevention or treatment of PHF is desirable.Trial registrationClinicalTrials.gov Identifier: NCT00489827https://clinicaltrials.gov/ct2/show/NCT00489827?term=glutamics&draw=2&rank=1.
Highlights
Postoperative heart failure (PHF) is the main cause for mortality after cardiac surgery but unbiased evaluation of PHF is difficult
There were a total of 382 consenting patients with acute coronary syndrome undergoing isolated first-time coronary artery bypass surgery (CABG) with at least one available NT-proBNP as follows: preoperative (n = 366), postoperative day 1 (POD1; n = 320), and postoperative day 3 (POD3; n = 325) and data from all three time points available in 267 patients
Overall NT-proBNP increased from 420 [150–970] ng/L preoperatively to 2065 [1324–3650] ng/L (p < 0.001) POD1 and to 3610 [2167–6010] ng/L (p < 0.001) POD3
Summary
Postoperative heart failure (PHF) is the main cause for mortality after cardiac surgery but unbiased evaluation of PHF is difficult. Postoperative heart failure (PHF) accounts for the majority of deaths after cardiac surgery (O'Connor et al, 1998; Surgenor et al, 2001; Vanky et al, 2004). The Northern New England Cardiovascular Study group found that differences in postoperative mortality after coronary artery bypass surgery (CABG) were mainly explained by differences in mortality rates caused by PHF (O'Connor et al, 1998). PHF usually presents at weaning from cardiopulmonary bypass or early after surgery when patients have a low systemic oxygen demand due to anesthesia and, cardiac output can be very low even in patients with completely a normal postoperative course (Vanhanen et al, 1998; Hakanson et al, 1995). There are pitfalls, such as shivering, anemia and hypovolemia, SvO2 in the early postoperative course is well documented with regard to outcome and the pitfalls are usually recognizable (Holm et al, 2011; Holm et al, 2010; Svedjeholm et al, 1999)
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