Preoperative B-type Natriuretic Peptide Levels Research Articles

Preoperative renal dysfunction is a predictor of postoperative atrial fibrillation in coronary artery bypass patients

Purpose: Atrial fibrillation is the most common arrhythmia following cardiac surgery. An association between preoperative kidney dysfunction and postoperative atrial fibrillation has been previously reported; however, no study has so far investigated the impact of kidney function during cardiopulmonary bypass on the incidence of atrial fibrillation. The aim of this study was to investigate the value of preoperative renal function and urine output during cardiopulmonary bypass as predictors of postoperative atrial fibrillation in patients undergoing elective coronary artery bypass.
 Methods: This observational retrospective study included 409 patients who underwent elective coronary artery bypass surgery. According to whether or not atrial fibrillation developed postoperatively, the patients were divided into a sinus rhythm group (n = 340) and a new-onset atrial fibrillation group (n = 69). The impact of preoperative (serum creatinine and estimated glomerular filtration rate) and intraoperative (urine output during cardiopulmonary bypass) kidney function on the incidence of new-onset postoperative atrial fibrillation was assessed using univariable and multivariable analyses.
 Results:Patients with atrial fibrillation were older, and had higher EuroSCORE II and higher preoperative B-type natriuretic peptide levels than patients with sinus rhythm. Preoperative renal function was worse (higher serum creatinine level and lower estimated glomerular filtration rate) in the atrial fibrillation group than in the sinus rhythm group. However, there were no differences between the groups in urine output during cardiopulmonary bypass. Multivariable analysis identified older age, left ventricular ejection fraction ≤30%, and lower preoperative estimated glomerular filtration rate as independent risk factors for new-onset postoperative atrial fibrillation.
 Conclusion: Preoperative renal function—but not urine output during cardiopulmonary bypass—is a predictor of new-onset postoperative atrial fibrillation in patients undergoing elective coronary artery bypass surgery.

B-type natriuretic peptide as a surrogate marker for survival in patients undergoing cardiac surgery.

BackgroundB-type natriuretic peptide (BNP) is a biomarker predicting morbidity and mortality in patients with congestive heart failure. However, the usefulness of pre- or postoperative BNP levels in patients undergoing cardiac surgery remains uncertain. We sought to determine the association of pre- or postoperative BNP levels on mortality in patients undergoing cardiac surgery under cardiopulmonary bypass (CPB).MethodsThis study retrospectively evaluated 1,642 patients undergoing cardiac surgery under CPB over 2 years. The primary outcomes were 30-day and overall mortality after cardiac surgery.ResultsThe 30-day mortality rate was 3.0% (n=49), and the overall mortality occurred in 118 patients during the mean follow-up period of 24.9±8.9 months. In multivariable analyses, preoperative BNP level was not significantly associated with 30-day [odds ratio (OR), 1.03; 95% confidence interval (CI), 0.99–1.06; P=0.06] or overall [hazard ratio (HR), 1.01; 95% CI, 0.98–1.03; P=0.50] mortalities. However, the postoperative BNP level was significantly associated with 30-day (OR, 1.05; 95% CI, 1.02–1.09; P=0.001) and overall (HR, 1.03; 95% CI, 1.01–1.04; P=0.01) mortalities. As a sensitivity analysis, postoperative BNP levels were divided into quartiles. The top quartile (≥484 pg/mL) was identified as a strong predictor of overall mortality (HR, 2.18; 95% CI, 1.14–4.19; P=0.02).ConclusionsPreoperative BNP level was not associated with mortality after cardiac surgery. However, postoperative BNP level was associated with mortality after cardiac surgery, especially in patients with high levels (≥484 pg/mL). Further studies in larger cohorts are necessary to validate these results.

Increasing Age Hinders the Decline in B-Type Natriuretic Peptide Following Parathyroidectomy in Dialysis Patients

Parathyroidectomy has beneficial effects on all-cause and cardiovascular mortality in patients with uncontrolled hyperparathyroidism. B-Type natriuretic peptide (BNP) correlates with the severity of heart failure. We aimed to investigate whether parathyroidectomy modulates the BNP levels in dialysis patients. Patients who underwent surgical intervention for hyperparathyroidism were included. The serum BNP levels were determined before parathyroidectomy and during follow-up. The preoperative and postoperative BNP levels were 499±561 and 453±442 pg/ml, respectively (p=0.82). The baseline BNP level was positively correlated with weakness and headache, but not biochemical parameters. In multivariate analysis, age (odds ratio=0.837) and preoperative symptom score (odds ratio=0.935) were independent predictors for the postoperative decline in BNP levels Conclusion: The serum BNP levels may increase or decrease after parathyroidectomy. Younger age and lower symptom burden are associated with decline in BNP levels.

B-type Natriuretic Peptide and Other Risk Factors for Predicting Postoperative Atrial Fibrillation after Thoracic Surgery.

Postoperative atrial fibrillation (POAF) is associated with increased morality rate, prolonged hospitalization, and reduced long-term survival after surgery. Thus, prediction of POAF is important to assess surgical risk and provide prophylaxis. It was a prospective study of 207 consecutive patients who underwent a routine preoperative laboratory testing before thoracic surgery from October 2016 to May 2017. Comprehensive data were collected. Then stepwise multivariate logistic regression analysis was adopted to identify significant risk factors associated with POAF from various variables. As results, three variables as follows: male gender, open thoracotomy, and B-type natriuretic peptide (BNP) exceeding 59 pg/mL were considered as independent risk factors associated with POAF (p < 0.05). In patients undergoing noncardiac thoracic surgery, we found that an elevated preoperative BNP level (with the level of 59 pg/mL as a cutoff), male gender, and open-chest surgeries were significant risk factors for POAF. The identification of patients who are prone to develop POAF will provide prevention strategies to reduce this complication.

High Preoperative B-type Natriuretic Peptide Level a Good Predictor of Ejection Fraction Improvement after Coronary Bypass Surgery

High Preoperative B-type Natriuretic Peptide Level a Good Predictor of Ejection Fraction Improvement after Coronary Bypass Surgery

A Double-Blind Placebo-Controlled Study of the Effects of Olprinone, a Specific Phosphodiesterase III Inhibitor, for Preventing Postoperative Atrial Fibrillation in Patients Undergoing Pulmonary Resection for Lung Cancer

We previously reported that patients with elevated preoperative B-type natriuretic peptide (BNP) levels have an increased risk for postoperative atrial fibrillation following lung cancer surgery. The present study evaluated whether the specific phosphodiesterase III inhibitor olprinone can reduce the incidence of postoperative atrial fibrillation in patients with elevated BNP levels undergoing pulmonary resection for lung cancer. A prospective randomized study was conducted with 40 patients who had elevated preoperative BNP levels (≥ 30 pg/mL) and underwent scheduled lung cancer surgery. All patients were in sinus rhythm at surgery. Low-dose olprinone or placebo was continuously infused for 24 h and started just before anesthesia induction. The primary end point was the incidence of postoperative atrial fibrillation. The secondary end points were perioperative hemodynamics and levels of BNP, WBC counts, and C-reactive protein. The incidence of postoperative atrial fibrillation was significantly lower in the olprinone group than in the placebo group (10% vs 60%, P < .001). Patients in the olprinone group showed significantly lower BNP, WBC counts, and C-reactive protein levels after surgery. Continuous infusion of olprinone during lung cancer surgery was safe and reduced the incidence of postoperative atrial fibrillation following pulmonary resection in patients with elevated preoperative BNP levels. Japan Primary Registries Network; No.: JPRN-UMIN2404; URL: http://www.umin.ac.jp/ctr/.

B-type natriuretic peptide-guided risk assessment for postoperative complications in lung cancer surgery.

Since lung cancer surgery is still associated with a high complication rate, it is important to efficiently identify patients at high risk for postoperative complications following lung cancer surgery. We previously reported that elderly patients with elevated preoperative B-type natriuretic peptide (BNP) levels (>30 pg/mL) have an increased risk for postoperative atrial fibrillation and cardiopulmonary complications following lung cancer surgery. The objective of this study was to evaluate the clinical utility of BNP-guided risk classification for postoperative complications after lung cancer surgery. A total of 675 consecutive patients who underwent curative surgery for lung cancer in two specialized thoracic centers between 2007 and 2011 were included in this retrospective study. We evaluated the association between the incidence of postoperative complications and preoperative BNP levels. Univariable and multivariable stepwise logistic regression analyses revealed that an elevated preoperative BNP level was the most significant predictor of postoperative complications. All patients were classified by their preoperative BNP levels into a normal group (<30 pg/mL), a mildly elevated group (30-100 pg/mL), and a severely elevated group (>100 pg/mL). The incidence of postoperative complications was significantly higher in the severely and mildly elevated groups than in the control group (85 % and 47 % vs. 11 %, P < 0.0001). Furthermore, there were more severe complications and a higher mortality rate in the severely elevated group. Risk assessment using preoperative BNP levels was clinically useful for the identification of patients at high risk for postoperative complications.

Comparison between the level of interleukin-6 and B-type natriuretic peptide as predictors of the outcome after coronary artery bypass graft surgery

Introduction The B-type natriuretic peptide (BNP) and interleukin-6 (IL-6) are increasingly being used as biomarkers for the diagnosis, management, and prognosis of complications after cardiac surgery with cardiopulmonary bypass (CPB). The aim of this study was to assess preoperative and postoperative levels of BNP and IL-6 in patients undergoing coronary artery graft surgery (CABG) with CPB and investigate their variation and ability to correlate with immediate postoperative outcome. Patients and Methods Patients scheduled for elective CABG with CPB were enrolled in this study. Plasma levels of BNP and IL-6 were measured preoperatively, 6, 12, and 24 h after CPB. The main endpoints were the correlation between the level of BNP and IL-6 and the requirements for an intra-aortic balloon pump, artificial ventilation for more than 24 h, intensive care unit (ICU) stay longer than 5 days, requirement for inotropic support, hospital stay, and clinical complications (infection, myocardial infarction, ventricular arrhythmias, stroke, or renal failure). Results Sixty-eight patients (eight women and 60 men), median age 63.3 ± 6.9 years, were included in the study. Preoperative BNP levels correlated with longer ICU stay (P = 0.003), longer mechanical ventilation (P = 0.016), and longer epinephrine and milrinone use (P Conclusion BNP correlates with clinical endpoints more than IL-6 and both can be used together as predictors of early outcome after coronary artery bypass grafting surgery.

Utility of perioperative B-type natriuretic peptide in off-pump bypass surgery

Background and Aims: This study was performed to determine clinical relevance of perioperative B-type natriuretic peptide (BNP) in patients undergoing off-pump coronary artery bypass grafting. Methods: 145 consecutive patients undergoing off-pump coronary artery bypass grafting during 8-month period were enrolled in this study. The relationship between the plasma BNP and various clinical parameters was examined. Postoperatively their main clinical endpoints including requirement of mechanical ventilator support, length of intensive care unit stay and hospital stay was closely monitored. Results: Mean preoperative BNP levels were significantly higher in patients whose left ventricular ejection fraction was less than 0.50 (P&lt;0.00083), and New York Heart Association class (III, IV) (P&lt;0.02). The determinants of preoperative higher level of BNP can be related to the advanced age of the patients, r=0.387 (P&lt;0.01) and left ventricular end diastolic diameter, r=0.200 (P&lt;0.05). Postoperative 12-hour BNP correlated significantly with the duration of mechanical ventilation, rho=0.84 (P&lt;0.05), and postoperative hospital stay for 10 days or more, rho=0.202 (P&lt;0.05). Logistic regression analyses showed a significant association between 12-hour BNP and the requirement of mechanical ventilation, Wald=3.956 (P&lt;0.049, 95% CI_1.023- 20.476). Conclusion: Plasma BNP concentration is a valuable biochemical marker, is easy to measure and can effectively predict postoperative outcome in off-pump coronary artery bypass grafting. Baseline BNP had strong correlation with the age and ventricular function of the patient. Postoperatively, elevated 12-hour BNP indicated prolonged ventilation and longer duration of hospital stay. DOI: http://dx.doi.org/10.3126/njh.v11i1.10977 Nepalese Heart Journal 2014;11(1): 19-25

Are preoperative B-type natriuretic peptide levels associated with outcome after pulmonary artery banding and the double switch operation in patients with congenitally corrected transposition of the great arteries: A pilot study

From the Division of Pediatric Anesthesia, Department of Anesthesiology, Stanford University School of Medicine, Stanford, Calif; Department of Epidemiology and Biostatistics, University of California, San Francisco, Calif; Pediatric Heart Center, Lucile Packard Children’s Hospital, Stanford University School of Medicine, Stanford, Calif; and Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of California, San Francisco, Calif. This study was made possible by funding from the Pediatric Heart Center Research Program, Lucile Packard Foundation for Children’s Health, Stanford CTSA (grant number UL1 RR025744). Disclosures: Authors have nothing to disclose with regard to commercial support. Received for publication April 17, 2014; revisions received June 17, 2014; accepted for publication July 7, 2014; available ahead of print Aug 16, 2014. Address for reprints: Danton S. Char, MD, Department of Anesthesiology, H3580, Stanford University Medical Center, 300 Pasteur Drive, Stanford, CA 94305 (E-mail: dchar@stanford.edu). J Thorac Cardiovasc Surg 2014;148:2434-6 0022-5223/$36.00 Copyright 2014 by The American Association for Thoracic Surgery http://dx.doi.org/10.1016/j.jtcvs.2014.07.003

Preoperative B-type natriuretic peptide levels are associated with outcome after total cavopulmonary connection (Fontan)

The study objective was to determine the association between preoperative B-type natriuretic peptide levels and outcome after total cavopulmonary connection. Surgical palliation of univentricular cardiac defects requires a series of staged operations, ending in a total cavopulmonary connection. Although outcomes have improved, there remains an unpredictable risk of early total cavopulmonary connection takedown. Theprediction of adverse postoperative outcomes is imprecise, despite an extensive preoperative evaluation. We prospectively enrolled 50 patients undergoing total cavopulmonary connection. We collected preoperative clinical data, preoperative plasma B-type natriuretic peptide levels, and postoperative outcomes, including the incidence of an adverse outcome within 1 year of surgery (defined as death, total cavopulmonary connection takedown, or the need for cardiac transplantation). The mean age of patients was 4.7 years (standard deviation, 2.1 years). The median (interquartile range) preoperative B-type natriuretic peptide levels were higher in patients who required total cavopulmonary connection takedown and early postoperative mechanical cardiac support (n=3; median, 55; interquartile range, 42-121) compared with those with a good outcome (n=47; median, 11; interquartile range, 5-17) (P<.05). A preoperative B-type natriuretic peptide level of 40 pg/mL or greater was highly associated with the need for total cavopulmonary connection takedown (sensitivity, 100%; specificity, 93%; P < .05), yielding a positive predictive value of 50% and a negative predictive value of 100%. Higher preoperative B-type natriuretic peptide levels also were associated with longer intensive care unit length of stay, longer hospital length of stay, and increased incidence of low cardiac output syndrome (P<.05). Preoperative B-type natriuretic peptide blood levels are uniquely associated with the need for mechanical support early after total cavopulmonary connection and total cavopulmonary connection takedown, and thus may provide important information in addition to the standard preoperative assessment.

The Effects of Perioperative Inhaled Iloprost on Pulmonary Hypertension with Congenital Heart Disease

Objectives: The treatment of choice for congenital heart disease (CHD) with pulmonary arterial hypertension (PAH) is still controversial. We assessed the efficacy and safety of perioperative inhaled iloprost therapy in CHD with PAH. Methods: Among 45 patients with a ventricular septal defect and/or an atrial septal defect with PAH, 28 patients were treated with inhaled iloprost before and after surgery. Perioperative clinical parameters and plasma B-type natriuretic peptide (BNP) were evaluated. Results: No statistical difference in the estimated right ventricular systolic pressure (e-RVP), the e-RVP-to-systemic pressure ratio, and preoperative BNP levels between the iloprost group and the control group were found. Among the iloprost group, oxygen saturation was increased significantly after iloprost inhalation therapy (p = 0.0052). The iloprost group was also significantly correlated with less use of inhaled nitric oxide in the immediate postoperative period compared to the control group (p = 0.021). The durations of mechanical ventilation (p = 0.018), ICU stay (p = 0.005), and chest tube use (p = 0.039) were significantly shorter in the iloprost group compared to the control group. The plasma BNP, checked on 7th day of postoperatively, was lower in the iloprost group than in the control group (p = 0.008). Conclusion: Perioperative inhaled iloprost therapy showed the benefit of cardiac functional improvement and early weaning of postoperative supportive care in the management of CHD with PAH.

Preoperative B-type Natriuretic Peptide as a Predictor of Postoperative Cardiac Events Following Orthopedic Elderly Patients

Background: The aim of this study was to evaluate the value of preoperative plasma B-type natriuretic peptide (BNP) level in predicting postoperative in-hospital major adverse cardiac events (MACE, defined as atrial fibrillation, congestive heart failure, nonfatal myocardial infarction and cardiac death) in elderly patients undergoing orthopedic surgery. Methods: Between March 2010 and September 2011, data from 156 patients (aged 65 years or older) who underwent scheduled or emergent orthopedic surgery, were investigated. Screening for postoperative in-hospital MACE was performed using clinical criteria. Results: MACE occurred in 12 patients (7.7%). The BNP level was significantly higher in patients with MACE than in those without (median, 152.0; interquartile range [36.3 to 352.8] pg/mL vs. median, 36.8; interquartile range [15.5 to 98.1] pg/mL, p=0.005). The BNP level was positively correlated with the revised cardiac risk index score (r=0.300, p=0.001). In a receiver operating characteristic (ROC) analysis for MACE, the ROC for BNP was 0.746 (95% confidence interval, 0.602 to 0.891). At the optimal cut-off point (BNP=110 pg/mL), the sensitivity, specificity and positive and negative predictive values were 66.7, 81.2, 22.0% and 96.6%, respectively. On multivariate analysis, preoperative BNP was an independent predictor for MACE (odds ratio, 5.091; p=0.018) after adjusting for baseline confounding factors such as diabetes mellitus and history of cerebrovascular accident. Conclusion: The preoperative BNP level may be a useful tool in stratifying the risk for MACE in elderly patients undergoing orthopedic surgery.

B-type natriuretic peptide predicts postoperative cardiac events and mortality after elective open abdominal aortic aneurysm repair

The aim of this study was to determine if a single preoperative B-type natriuretic peptide (BNP) level correlated with perioperative cardiac events, cardiac death, and all-cause mortality in elective open abdominal aortic aneurysm (AAA) repair in the short term, intermediate term, and long term. A prospective, 2-year multicenter observational cohort study in the three vascular units in Glasgow was performed. All patients who were admitted for elective open AAA repair were recruited. Preoperative BNP levels were performed and batch analyzed at the end of the study. Postoperative screening for cardiac events (nonfatal myocardial infarction and cardiac death) was performed at 2, 5, and 30 days. Follow-up for all-cause mortality was sustained to a minimum of 3 years, where possible. A total of 106 of 111 patients were recruited. Median BNP concentrations were higher in the 16 patients (15%) with immediate postoperative cardiac events (P = .001) and the five with cardiac death (P = .043). Area under the receiver-operating characteristic (AUC) curve analysis indicated BNP concentrations of 99.5 pg/mL best predicted cardiac events (AUC, 0.927), and 448 pg/mL predicted cardiac death (AUC, 0.963). BNP also predicted all-cause mortality in the short-term (P = .028), intermediate-term (P < .001), and long-term (P < .001) postoperative periods. Preoperative serum BNP concentration predicted postoperative cardiac events, cardiac death, and all-cause mortality in patients undergoing elective open AAA repair on short-term, intermediate-term, and long-term follow-up on an individual basis with greater accuracy than currently available risk prediction tools.

B-type natriuretic peptide levels predict outcomes in infants undergoing cardiac surgery in a lesion-dependent fashion

B-type natriuretic peptide is used in the diagnosis, risk stratification, and management of adult patients with cardiac disease. However, its use in infants with congenital heart disease has been limited, particularly in the perioperative period. Our objective was to determine the alterations in perioperative B-type natriuretic peptide levels and their predictive value on postoperative outcomes, in infants undergoing congenital heart surgery. We prospectively enrolled 115 patients: 24 with univentricular heart disease undergoing a modified Norwood procedure, 11 with d-transposition of the great arteries, 55 with hemodynamically important left-to-right shunt, and 25 with tetralogy of Fallot undergoing primary repair. Clinical data and B-type natriuretic peptide samples were collected before and 2, 12, and 24 hours after cardiopulmonary bypass. Univariate analysis and multivariate linear regression analysis were performed. The perioperative B-type natriuretic peptide levels were lesion specific. Patients with d-transposition of the great arteries and univentricular heart disease had high preoperative B-type natriuretic peptide levels that decreased postoperatively, and those with hemodynamically important left-to-right shunts and tetralogy of Fallot had lower preoperative levels that increased during the first 12 hours postoperatively. The patients with univentricular heart disease with an adverse outcome had a significantly greater 24-hour B-type natriuretic peptide level than those without (P<.05). Those with hemodynamically important left to right shunts and an adverse outcome had a greater 12-hour B-type natriuretic peptide level than those without (P<.05). A 12-hour postoperative/preoperative ratio greater than 45 was 100% sensitive and 82% specific for an adverse outcome in the patients with tetralogy of Fallot. The perioperative changes in B-type natriuretic peptide levels and their ability to predict outcomes are lesion-specific. Characterization of these changes might be useful in caring for infants after congenital heart surgery.

Prognostic Power of Pre- and Postoperative B-Type Natriuretic Peptide Levels in Patients Undergoing Abdominal Aortic Surgery

The first aim of the present study was to evaluate the pre- and postoperative B-type natriuretic peptide (BNP) levels in patients undergoing surgery for repair of an infrarenal abdominal aortic aneurysm (AAA) and analyze their power as a predictor of in-hospital cardiac events. The second aim was to evaluate the association among pre- and postoperative BNP levels, postoperative patient complications, and length of hospital stay. Prospective observational study. A university hospital. Forty-five patients undergoing elective surgery for an abdominal aortic aneurysm. The plasma BNP level was assessed just before surgery and then on postoperative day 1. Cardiac troponin I levels were measured postoperatively on arrival to the intensive care unit (time 0) and then 12, 48, and 72 hours later. The preoperative BNP concentration in patients who developed an acute myocardial infarction was 209 (IQR 84-346) pg/mL compared with 74 (IQR 28-142) pg/mL in those who did not. The difference between groups was statistically significant (p = 0.04). The Spearman correlation showed that postoperative BNP levels correlated significantly with preoperative BNP levels (r = 0.73, p = 0.0001), length of hospital stay (r = 0.35, p = 0.04), and troponin I concentration at 0 hour (r = 0.42, p = 0.02), 12 hours (r = 0.51, p = 0.0052), and 48 hours (r = 0.40, p = 0.033). In contrast, preoperative BNP levels correlated with troponin I at only 12 hours (r = 0.34, p = 0.02). Postoperative BNP levels were influenced significantly by transfusions (p = 0.035) and cross-clamping times (p = 0.038). The present results confirm the high negative predictive value of preoperative BNP levels; and postoperative BNP levels showed a better correlation with postoperative troponin levels, blood transfusion, and postoperative cardiac events.

Effects of low-dose human atrial natriuretic peptide for preventing post-operative cardiopulmonary complications in elderly patients undergoing pulmonary resection for lung cancer

The objective of the present study was to evaluate the clinical effects of human atrial natriuretic peptide (hANP) on post-operative cardiopulmonary complications in elderly patients undergoing pulmonary resection for lung cancer. A retrospective study involving 44 consecutive patients aged ≥75 years who had elevated pre-operative B-type natriuretic peptide levels (≥30 pg/ml) and underwent a scheduled pulmonary resection for lung cancer in two specialized thoracic centres between April 2008 and March 2010. Results were compared between the patients who did and did not receive hANP during the perioperative period. The primary endpoint was the incidence of post-operative cardiopulmonary complications. Post-operative haemodynamics, white blood cell (WBC) counts and C-reactive protein (CRP) levels were also examined. The incidence of post-operative cardiopulmonary complications was significantly lower in the hANP group than that in the control group (26 vs. 86%, P < 0.0001). Patients in the hANP group showed significantly lower WBC counts and serum CRP levels post-operatively. Continuous infusion of low-dose hANP during lung cancer surgery had a prophylactic effect on post-operative cardiopulmonary complications in elderly lung cancer patients. ( JPRN-UMIN000003631).

Effect of low-dose human atrial natriuretic peptide on postoperative atrial fibrillation in patients undergoing pulmonary resection for lung cancer: A double-blind, placebo-controlled study

We previously reported that patients with preoperative B-type natriuretic peptide levels of 30 pg/mL or more have increased risk of postoperative atrial fibrillation after pulmonary resection. This study evaluated the effects of human atrial natriuretic peptide on postoperative atrial fibrillation in patients undergoing pulmonary resection for lung cancer. A prospective, randomized study was conducted with 40 patients who had preoperative elevated B-type natriuretic peptide (≥ 30 pg/mL) and underwent a scheduled pulmonary resection for lung cancer. Results were compared between patients who received low-dose human atrial natriuretic peptide and those who received a placebo. The primary end point was the incidence of postoperative atrial fibrillation during the first 4 days after surgery. The incidence of postoperative atrial fibrillation was significantly lower in the human atrial natriuretic peptide group than in the placebo group (10% vs 60%; P < .001). Patients in the human atrial natriuretic peptide group also showed significantly lower white blood cell counts and C-reactive protein levels after surgery. Continuous infusion of low-dose human atrial natriuretic peptide during lung cancer surgery had a prophylactic effect against postoperative atrial fibrillation after pulmonary resection in patients with preoperative elevation of B-type natriuretic peptide levels. A larger sample size is needed to establish the safety and efficacy of this intervention.

B-Type Natriuretic Peptide as a Predictor of Postoperative Cardiopulmonary Complications in Elderly Patients Undergoing Pulmonary Resection for Lung Cancer

The objective of the present study was to evaluate the utility of B-type natriuretic peptide for prediction of postoperative cardiopulmonary complications in elderly patients undergoing pulmonary resection for lung cancer. A prospective observational study was performed involving 80 consecutive patients aged 75 years or older who underwent a scheduled pulmonary resection for lung cancer in two specialized thoracic centers between January 2008 and June 2010. Baseline clinical details were obtained, and spirometry and examination of serum B-type natriuretic peptide levels were performed before surgery. The primary endpoint was the incidence of postoperative cardiopulmonary complications. Postoperative cardiopulmonary complications were identified in 34 (43%) patients; these patients had significantly higher preoperative B-type natriuretic peptide levels than those without cardiopulmonary complications (84.0±93.7 pg/mL vs 22.0±18.2 pg/mL; p<0.0001). The area under the receiver operating characteristic curve for B-type natriuretic peptide to predict postoperative cardiopulmonary complications after pulmonary resection for lung cancer was 0.85 (95% confidence interval 0.76 to 0.94; p<0.0001). A B-type natriuretic peptide value of 30 pg/mL had a sensitivity of 79% and a specificity of 83% for predicting postoperative cardiopulmonary complications after pulmonary resection for lung cancer. The incidences of both cardiovascular and respiratory complications were significantly higher in patients with preoperative B-type natriuretic peptide levels of 30 pg/mL or more. Preoperative B-type natriuretic peptide level could be a useful predictor of postoperative cardiopulmonary complications in elderly patients after pulmonary resection for lung cancer.

Usefulness of Plasma B-Type Natriuretic Peptide in the Assessment of Disease Severity and Prediction of Outcome after Aortic Valve Replacement in Patients with Severe Aortic Stenosis

The diagnostic and prognostic value of plasma B-type natriuretic peptide (BNP) level in isolated aortic stenosis (AS) has not been fully understood. BNP level was determined in 109 consecutive patients with isolated severe AS (68.1 ± 10.6 years; 53 men; transvalvular peak gradient, 87.2 ± 37.0 mm Hg; valve area index, 0.43 ± 0.14 cm(2)/m(2)) and 12 healthy volunteers in their stable state. They were followed up for 36 months. BNP level increased with New York Heart Association (NYHA) class (75.2 ± 95.9 pg/mL, 135.0 ± 112.0 pg/mL, 450.6 ± 366.3 pg/mL, and 1478.9 ± 941.5 pg/mL for NYHA I, II, III, and IV, respectively). Left ventricular (LV) mass index had the best relationship with BNP (r= 0.73, P < .0001). Aortic valve replacement (AVR) was eventually performed in 95 patients (male= 44, age= 67.8 ± 9.3 years). Echocardiography was repeated early (n= 88, 13.2 ± 6.2 day) and late (n= 62, 32 ± 10 months) after AVR. Preoperative BNP level correlated with LV mass index early (r= 0.74, P < .0001) and late (r= 0.78, P < .0001) after AVR. Patients with higher BNP level had a tendency to show cardiac symptoms (NYHA > I) late after AVR (NYHA I vs. > I= 160.8 ± 197.9 pg/mL vs. 504.3 ± 567.3 pg/mL, P < .0001). Preoperative BNP level predicted the occurrence of perioperative complications (P < .0001). During follow-up of the 94 patients (44 ± 10 months after AVR), 10 were readmitted for major cardiac and cerebrovascular events, including 9 patients with congestive heart failure and 1 patient with ischemic stroke. An event-free survival rate was significantly higher in patients with BNP ≤ 312 pg/mL than in patients with BNP > 312 pg/mL (log rank, χ(2)= 10.21, P= .001). Multiple logistic regression analysis revealed that BNP > 312 pg/mL was an independent predictor of AVR complication (odds ratio 5.58; confidence interval, 1.82-20.16; P= .002). Furthermore, BNP was the strongest predictor of major adverse cardiac and cerebrovascular events within 36 months after AVR (odds ratio 8.80; confidence interval, 1.83-42.35; P= .006). Plasma BNP level reflects the degree of heart failure, is associated with LV structure and function in severe AS, and is an independent predictor of complication and outcome after AVR. BNP level may be useful in risk stratification of patients with AS in conjunction with other clinical and echocardiographic parameters.