N-terminal pro-brain natriuretic peptide and outcomes in patients undergoing surgical ventricular restoration.

N-terminal pro-brain natriuretic peptide (NT-pro-BNP) levels have been shown to be increased at baseline in patients undergoing surgical ventricular restoration (SVR) of the left ventricle. However, changes in the values of this marker in the early postoperative period and its prognostic significance remain less known in these patients. We evaluated 31 consecutive patients undergoing SVR who had NT-pro-BNP determined a day before SVR and from postoperative days 0 to 4. Major morbidity was defined as > or =1 of the following: ventilation >48 hours, stroke, acute renal failure, low cardiac output, reoperation, or mediastinitis. The association of preoperative NT-pro-BNP with perioperative outcomes was assessed using multivariable logistic regression analysis. Receiver operating characteristic curve was used to test its discrimination power. Major morbidity occurred in 16 patients (52%) with only 1 death within 30 days of SVR. Mean preoperative NT-pro-BNP was 4.5-fold higher in patients with postoperative major morbidity than in those without it (3,022 +/- 2,981 vs 676 +/- 533 pg/ml, p = 0.007). On multivariate analysis, preoperative NT-pro-BNP was independently associated with major morbidity after adjusting for baseline confounding, particularly age, ejection fraction, and European System for Cardiac Operative Risk Evaluation (odds ratio 1.002, 95% confidence interval 1.001 to 1.003, p = 0.032). Preoperative NT-pro-BNP had a high discrimination power on receiver operating characteristic analysis for major morbidity (area under the curve 0.84, sensitivity 68%, and specificity 88% for 1,304 pg/ml). Although NT-pro-BNP levels decreased after SVR in patients without major morbidity, their levels remained persistently increased in those with it. In conclusion, preoperative NT-pro-BNP determination may be of value in stratifying the risk for major morbidity after SVR.

Duke Scholars

Author Rajendra H. Mehta Medicine, Cardiology