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Usefulness of repeated N-terminal pro-B-type natriuretic peptide measurements as incremental predictor for long-term cardiovascular outcome after vascular surgery.
Am J Cardiol. 2011 Feb 15; 107(4):609-14.AJ

Abstract

Plasma N-terminal pro-B-type natriuretic peptide (NT-pro-BNP) levels improve preoperative cardiac risk stratification in vascular surgery patients. However, single preoperative measurements of NT-pro-BNP cannot take into account the hemodynamic stress caused by anesthesia and surgery. Therefore, the aim of the present study was to assess the incremental predictive value of changes in NT-pro-BNP during the perioperative period for long-term cardiac mortality. Detailed cardiac histories, rest left ventricular echocardiography, and NT-pro-BNP levels were obtained in 144 patients before vascular surgery and before discharge. The study end point was the occurrence of cardiovascular death during a median follow-up period of 13 months (interquartile range 5 to 20). Preoperatively, the median NT-pro-BNP level in the study population was 314 pg/ml (interquartile range 136 to 1,351), which increased to a median level of 1,505 pg/ml (interquartile range 404 to 6,453) before discharge. During the follow-up period, 29 patients (20%) died, 27 (93%) from cardiovascular causes. The median difference in NT-pro-BNP in the survivors was 665 pg/ml, compared to 5,336 pg/ml in the patients who died (p = 0.01). Multivariate Cox regression analyses, adjusted for cardiac history and cardiovascular risk factors (age, angina pectoris, myocardial infarction, stroke, diabetes mellitus, renal dysfunction, body mass index, type of surgery and the left ventricular ejection fraction), demonstrated that the difference in NT-pro-BNP level between pre- and postoperative measurement was the strongest independent predictor of cardiac outcome (hazard ratio 3.06, 95% confidence interval 1.36 to 6.91). In conclusion, the change in NT-pro-BNP, indicated by repeated measurements before surgery and before discharge is the strongest predictor of cardiac outcomes in patients who undergo vascular surgery.

Authors+Show Affiliations

Department of Vascular Surgery, Erasmus Medical Center, Rotterdam, The Netherlands.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

21185000

Citation

Goei, Dustin, et al. "Usefulness of Repeated N-terminal pro-B-type Natriuretic Peptide Measurements as Incremental Predictor for Long-term Cardiovascular Outcome After Vascular Surgery." The American Journal of Cardiology, vol. 107, no. 4, 2011, pp. 609-14.
Goei D, van Kuijk JP, Flu WJ, et al. Usefulness of repeated N-terminal pro-B-type natriuretic peptide measurements as incremental predictor for long-term cardiovascular outcome after vascular surgery. Am J Cardiol. 2011;107(4):609-14.
Goei, D., van Kuijk, J. P., Flu, W. J., Hoeks, S. E., Chonchol, M., Verhagen, H. J., Bax, J. J., & Poldermans, D. (2011). Usefulness of repeated N-terminal pro-B-type natriuretic peptide measurements as incremental predictor for long-term cardiovascular outcome after vascular surgery. The American Journal of Cardiology, 107(4), 609-14. https://doi.org/10.1016/j.amjcard.2010.10.021
Goei D, et al. Usefulness of Repeated N-terminal pro-B-type Natriuretic Peptide Measurements as Incremental Predictor for Long-term Cardiovascular Outcome After Vascular Surgery. Am J Cardiol. 2011 Feb 15;107(4):609-14. PubMed PMID: 21185000.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Usefulness of repeated N-terminal pro-B-type natriuretic peptide measurements as incremental predictor for long-term cardiovascular outcome after vascular surgery. AU - Goei,Dustin, AU - van Kuijk,Jan-Peter, AU - Flu,Willem-Jan, AU - Hoeks,Sanne E, AU - Chonchol,Michel, AU - Verhagen,Hence J M, AU - Bax,Jeroen J, AU - Poldermans,Don, Y1 - 2010/12/22/ PY - 2010/08/09/received PY - 2010/10/05/revised PY - 2010/10/05/accepted PY - 2010/12/28/entrez PY - 2010/12/28/pubmed PY - 2011/4/9/medline SP - 609 EP - 14 JF - The American journal of cardiology JO - Am J Cardiol VL - 107 IS - 4 N2 - Plasma N-terminal pro-B-type natriuretic peptide (NT-pro-BNP) levels improve preoperative cardiac risk stratification in vascular surgery patients. However, single preoperative measurements of NT-pro-BNP cannot take into account the hemodynamic stress caused by anesthesia and surgery. Therefore, the aim of the present study was to assess the incremental predictive value of changes in NT-pro-BNP during the perioperative period for long-term cardiac mortality. Detailed cardiac histories, rest left ventricular echocardiography, and NT-pro-BNP levels were obtained in 144 patients before vascular surgery and before discharge. The study end point was the occurrence of cardiovascular death during a median follow-up period of 13 months (interquartile range 5 to 20). Preoperatively, the median NT-pro-BNP level in the study population was 314 pg/ml (interquartile range 136 to 1,351), which increased to a median level of 1,505 pg/ml (interquartile range 404 to 6,453) before discharge. During the follow-up period, 29 patients (20%) died, 27 (93%) from cardiovascular causes. The median difference in NT-pro-BNP in the survivors was 665 pg/ml, compared to 5,336 pg/ml in the patients who died (p = 0.01). Multivariate Cox regression analyses, adjusted for cardiac history and cardiovascular risk factors (age, angina pectoris, myocardial infarction, stroke, diabetes mellitus, renal dysfunction, body mass index, type of surgery and the left ventricular ejection fraction), demonstrated that the difference in NT-pro-BNP level between pre- and postoperative measurement was the strongest independent predictor of cardiac outcome (hazard ratio 3.06, 95% confidence interval 1.36 to 6.91). In conclusion, the change in NT-pro-BNP, indicated by repeated measurements before surgery and before discharge is the strongest predictor of cardiac outcomes in patients who undergo vascular surgery. SN - 1879-1913 UR - https://www.unboundmedicine.com/medline/citation/21185000/Usefulness_of_repeated_N_terminal_pro_B_type_natriuretic_peptide_measurements_as_incremental_predictor_for_long_term_cardiovascular_outcome_after_vascular_surgery_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002-9149(10)02104-1 DB - PRIME DP - Unbound Medicine ER -