Preoperative Brain Natriuretic Peptide Research Articles

Perioperative plasma brain natriuretic peptide and cardiotrophin-1 in off-pump coronary artery bypass

Objective. It has been suggested that brain natriuretic peptide (BNP) and cardiotrophin-1 (CT-1) are associated with myocardial dysfunction. The present prospective study was designed to investigate perioperative changes of plasma levels of BNP and CT-1 in off-pump coronary artery bypass (OPCAB). Method. Forty-nine patients undergoing elective OPCAB were divided into three groups. Group I: no previous myocardial infarction; Group II: previous myocardial infarction more than 12 weeks; Group III: recent myocardial infarction within 4–8 weeks. Perioperative BNP and CT-1 levels were measured, and hematochemical parameters were also collected. Results. Higher preoperative BNP and CT-1 levels were found in group III as compared to those in group I. BNP levels increased after operation, and reached peak value at 3–7 days after the operation. However, the postoperative changes of BNP levels were not different among groups in any time points. CT-1 levels did not change significantly after the operation as compared to baseline. Conclusion. Higher BNP and CT-1 levels were associated with recent myocardial infarction. BNP elevated after OPCAB, but CT-1 showed no significant postoperative changes. Postoperative changes of BNP and CT-1 do not associated with cardiac function in OPCAB.

Brain Natriuretic Peptide Levels Before and After Ventricular Septal Defect Repair

Brain natriuretic peptide is a relatively recently discovered circulating mediator that has been correlated with the degree of heart failure in adults. This study evaluated the preoperative and postoperative brain natriuretic peptide levels in infants and children undergoing ventricular septal defect repair. The study enrolled 18 infants and children (ages 2 months to 15.6 years) scheduled for surgical repair of their ventricular septal defects. Brain natriuretic peptide levels were drawn preoperatively and then postoperatively at 1, 24, 48, and 72 hours. The amount of shunt (the ratio of pulmonary blood flow [Q(p)]/systemic blood flow [Q(s)]) through the ventricular septal defect was determined by saturation levels performed in the catheterization laboratory or intraoperatively. The preoperative brain natriuretic peptide levels (pg/mL) averaged 78 +/- 57, and the postoperative levels were 168 +/- 241 at 1 hour, 418 +/- 330 at 24 hours, 405 +/- 364 at 48 hours, and 391 +/- 397 at 72 hours. These differences were significant for each postoperative time point compared with preoperative values. Preoperative brain natriuretic peptide and the Q(p)/Q(s) were significantly correlated (age-adjusted R(2) = 0.33, p < 0.001). Brain natriuretic peptide levels have a close correlation with the physiologic volume load caused by ventricular septal defects. The preoperative brain natriuretic peptide levels were also found to be predictive for the postoperative time course of brain natriuretic peptide level changes. These results suggest that brain natriuretic peptide levels may be a useful clinical marker in infants and children with ventricular septal defects.

Brain natriuretic peptide - a reliable parameter for the effectiveness of cardiac resynchronization therapy after coronary artery bypass grafting

Brain natriuretic peptide (BNP) is a valuable marker in heart failure and its therapy, for example cardiac resynchronization therapy (CRT). So far, one finding which is indicative for CRT is dyssynchrony of ventricular contraction obtained by echocardiography. The aim of this study was to show that BNP is also a helpful marker to help decide whether CRT is useful for patients after CABG. Forty-two patients with a poor ejection fraction (<35%) underwent elective CABG. Twenty-eight of them received permanent biventricular stimulation for seven days after surgery. Before and on the first, third, seventh and tenth day after surgical treatment, the following parameters were established: left ventricular function obtained by transthoracic echocardiography, myocardium-specific enzymes (such as CK and CKMB), ECG and BNP. There was a very good correlation between the preoperative ejection fraction and BNP (r2=0.98, P<0.005). Patients who had received CRT after CABG had BNP levels similar to preoperative data on postoperative day 7. This decrease of the BNP values in the CRT-group is in accord with an increased left ventricular function as obtained by echocardiography. The control group, which had not received CRT, showed significantly higher BNP levels. Therefore, we conclude that BNP is a good marker to evaluate CRT in patients undergoing CABG. An extraordinary rise of the BNP level should lead to early therapeutic consequences like CRT. The significantly lower BNP level of the patients with heart failure who received CRT indicates a better prognosis.

Prognostic significance of preoperative brain natriuretic peptide in patients undergoing major vascular surgery

Bolliger, D.; Rupinski, B. R.; Schumann, R. M.; Werner, C.; Seeberger, M. D.; Filipovic, M. Author Information

Brain Natriuretic Peptide Release in Cardiac Surgery Patients

Brain natriuretic peptide (BNP) release is a marker of increased myocardial wall tension, which is elevated in patients with disturbed left ventricular function. As it is increasingly being used as a reliable marker for diagnosis, optimization of pharmacological treatment, and risk stratification, BNP measurement might be also relevant for patients undergoing cardiac surgery. Measured BNP levels can be used to predict postoperative complications and the risk of further cardiac events. Preoperative BNP levels support the decision for the timing of aortic valve replacement in asymptomatic severe aortic stenosis. An increase in BNP levels early predicts allograft rejection after cardiac transplantation or ineffective cardiac resynchronization therapy. Moreover, BNP levels can be used to differentiate between cardiac and non-cardiac reasons for acute dyspnea in the management of surgical patients. Finally, the application of recombinant human BNP seems to improve recovery after cardiac surgical procedures. Thus, BNP can be a helpful tool for monitoring and treating patients before, during, and after cardiac surgery to predict and improve the effectiveness of therapy and reduce hospitalization and costs.

Plasma brain natriuretic peptide as a noninvasive marker for efficacy of pulmonary thromboendarterectomy

Background. Plasma brain natriuretic peptide (BNP), a cardiac hormone secreted mainly by the cardiac ventricles, has been shown to increase in proportion to the degree of cardiac overload. However, whether plasma BNP may serve as a marker for the efficacy of pulmonary thromboendarterectomy in patients with chronic thromboembolic pulmonary hypertension remains unknown. Methods. Plasma BNP level was measured in 34 patients with chronic thromboembolic pulmonary hypertension before and 1 month after pulmonary thromboendarterectomy. Right heart catheterization was also performed before and 1 month after the operation. Results. Preoperative plasma BNP level was significantly elevated in patients with chronic thromboembolic pulmonary hypertension compared with control patients (246 ± 40 vs 13 ± 2 pg/mL; p < 0.001; n = 34) and was positively correlated with total pulmonary resistance (r = 0.57; p < 0.001). After pulmonary thromboendarterectomy, plasma BNP level in survivors markedly decreased (220 ± 31 to 54 ± 9 pg/mL; p < 0.001; n = 32) in association with a reduction of total pulmonary resistance (15.6 ± 1.0 to 4.5 ± 0.3 Wood units; p < 0.001). The change in plasma BNP level was closely correlated with that in total pulmonary resistance (r = 0.63; p < 0.001). Importantly, a sustained elevation of plasma BNP (≥ 50 pg/mL) indicated the presence of residual pulmonary hypertension (≥ 5 Wood units) after operation (sensitivity = 73%; specificity = 81%). Conclusions. Plasma BNP level was strongly associated with the severity of pulmonary hypertension in patients with chronic thromboembolic pulmonary hypertension and thereby may serve as a noninvasive marker for the efficacy of pulmonary thromboendarterectomy.

Perioperative changes in plasma brain natriuretic peptide concentrations in patients undergoing cardiac surgery.

The plasma concentrations of brain natriuretic peptide (BNP), a cardiac hormone, were measured in 30 consecutive adult patients undergoing cardiac surgery with cardiopulmonary bypass (CPB) during the perioperative period. BNP concentrations remained unchanged until 6 h after the cessation of bypass, and were elevated 12, 24, and 48 h post-bypass (P < 0.0001 versus baseline). They had returned to the baseline values when measured 3 weeks postoperatively. The preoperative plasma BNP concentration correlated significantly with the left ventricular ejection fraction (r = -0.895). The peak plasma BNP concentration 24 h after bypass correlated with the cardiac index (r = -0.64), stroke volume index (r = -0.62), injection rate of dopamine hydrochloride (r = 0.65), and aortic crossclamp time (r = 0.57). There was also a significant correlation between the preoperative BNP concentration and the plasma BNP concentration 24 h post-CPB. These findings led us to conclude that the plasma concentrations of BNP become markedly and acutely elevated after cardiac surgery with CPB, and reflect the state of left ventricular function. Moreover, the severity of acute heart failure after cardiac surgery can be predicted by the preoperative plasma BNP concentration.

Plasma levels of brain and atrial natriuretic peptides elevate in proportion to left ventricular end-systolic wall stress in patients with aortic stenosis

Brain natriuretic peptide (BNP) is a novel cardiac hormone secreted predominantly from the ventricle. We examined the plasma levels of BNP and atrial natriuretic peptide (ANP) in 13 patients with aortic stenosis undergoing corrective surgery. Preoperative plasma BNP and ANP levels correlated highly with preoperative left ventricular end-systolic wall stress (ESS) ( r = 0.96, p < 0.0001 and r = 0.95, p < 0.0001, respectively). Moreover, between preoperative and late postoperative states, the difference of the plasma levels of BNP and ANP correlated with the difference of ESS. In two patients with elevated ESS and quite high preoperative plasma BNP (>1000 pg/ml), rapid decrease of the plasma level after operation was observed. These results suggest that synthesis and secretion of BNP and ANP are stimulated by the increase of left ventricular end-systolic wall stress in patients with aortic stenosis. (Am Heart J 1997;133:307-14.)

Brain natriuretic peptide and fluid volume homeostasis--studies during cardiopulmonary bypass surgery.

Brain natriuretic peptide (BNP) is a recently identified cardiac ventricular hormone with diuretic, natriuretic and vasorelaxant properties. The aim of our study was to examine whether serial changes in endogenous levels of BNP were associated with fluid volume homeostasis following cardiopulmonary bypass. We studied nine patients undergoing elective cardiac surgery for the repair of cardiac abnormalities requiring cardiopulmonary bypass. Urinary levels of cyclic guanosine monophosphate (cGMP), sodium, urine output, fluid balance, and plasma levels of BNP, aldosterone, plasma renin activity (PRA) and central venous pressure (CVP) were measured before, during and after cardiopulmonary bypass. Basal pre-operative plasma BNP levels were highly elevated in all nine patients with cardiac abnormalities. During bypass, pre-operative levels of BNP, urinary cGMP and plasma aldosterone decreased significantly (p < 0.05), whereas pre-operative levels of urinary sodium and PRA were slightly reduced. During recovery following bypass levels of urinary cGMP, sodium, PRA and aldosterone returned to basal pre-operative values, whereas post-operative levels of plasma BNP were found to be three-fold below basal pre-operative levels. CVP (4.3 +/- 0.2 mmHg) during the onset of bypass increased significantly (p < 0.05) at the end of bypass (9 +/- 0.3 mmHg) followed by a modest increase post-operatively (10 +/- 0.4 mmHg). After operation only BNP had a significant correlation with urine output (r = -0.82, p < 0.02) and net fluid balance (r = -0.84, p < 0.01), whereas urinary cGMP, PRA and aldosterone all exhibited a non-significant correlation with urine output.(ABSTRACT TRUNCATED AT 250 WORDS)