Increased NT-proBNP levels and cardiac ventricular function during aortic valve replacement (pilot study)
The objective was to study the relationship between the increased preoperative N-terminal segment of B-type natriuretic peptide precursor (NT-proBNP) blood levels and the parameters of the heart ventricles function, as well as the conditions for coronary perfusion of their myocardium before and afte...
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| Format: | Article |
| Language: | Russian |
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New Terra Publishing House
2023-07-01
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| Series: | Вестник анестезиологии и реаниматологии |
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| Online Access: | https://www.vair-journal.com/jour/article/view/825 |
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| author | I. A. Kozlov L. A. Krichevskiy V. Yu. Rybakov |
| author_facet | I. A. Kozlov L. A. Krichevskiy V. Yu. Rybakov |
| author_sort | I. A. Kozlov |
| collection | DOAJ |
| description | The objective was to study the relationship between the increased preoperative N-terminal segment of B-type natriuretic peptide precursor (NT-proBNP) blood levels and the parameters of the heart ventricles function, as well as the conditions for coronary perfusion of their myocardium before and after on-pump aortic valve replacement.Materials and methods. The study involved 27 patients aged 57.7±2.5 years who underwent aortic valve replacement. NT-proBNP blood level was determined before surgery. The level of NT-proBNP > 1000 pg/ml was considered increased. Invasive hemodynamics, including the data of the right ventricle thermodilution volumetry, and transesophageal echocardiography data were analyzed at the stages: the 1st – after anesthesia induction, the 2nd – at the end of surgery. Logistic regression and ROC analysis were used for data processing.Results. Preoperative blood levels of NT-proBNP > 1000 (3163.0[2507.25–7319]) pg/ml were recorded in 55.6% of patients. At the 1st stage, the biomarker increased level was associated with increased index of left ventricular end-systolic volume (OR 1.0955, 95% CI 1.0097–1.1885, p = 0.028, AUC 0.903), decreased left ventricular ejection fraction (OR 0, 9447, 95% CI 0.8949–0.9973, p = 0.040, AUC 0.753) and area contraction fraction (OR 0.8868, 95% CI 0.8086–0.9726, p = 0.011, AUC 0.890), increased mean pulmonary artery pressure (OR 1.1824, 95% CI 1.0020–1.3952, p = 0.047, AUC 0.722), and increased transpulmonary gradient (OR 1.4497, 95% CI 1.0103–2.0802, p = 0.044, AUC 0.810), increased right ventricular stroke work index (OR 1.5151, 95% CI 1.0319–2.2246, p = 0.034, AUC 0.761), and decreased coronary perfusion gradients of the left (OR 0.8961–0.9241, 95% CI 0.8229–0.9459 – 0.8630–0.9896, p = 0.012–0.024, AUC 0.793–0.861) and right (OR 0.9519, 95% CI 0.9136–0.9918, p = 0.019, AUC 0.847) ventricles. At the 2nd stage, NT-proBNP blood values > 1000 pg/ml were associated with impaired left ventricular function, decreased mean arterial pressure (OR 0.9066, 95% CI 0.8264–0.9946, p = 0.038, AUC 0.761), and the vasopressor and inotropic support (OR 8.4000, 95% CI 1.2584–56.0694, p = 0.028, AUC 0.710).Conclusions. Prior to aortic valve replacement, the blood level of NT-proBNP > 1000 pg/ml is associated with a moderate decrease in the left ventricular ejection fraction and area contraction fraction, an increased left ventricular end-systolic volume with a normal end-diastolic volume, an increased index of right ventricular stroke work in combination with moderately increased mean pulmonary artery pressure and increased transpulmonary gradient, as well as a decreased coronary perfusion gradients. At the end of operations, increased NT-proBNP blood level is associated with signs of impaired left ventricular contractility, a tendency to arterial hypotension, and the vasopressor and inotropic support. Increased preoperative NT-proBNP blood level are not associated with right ventricular volumes and ejection fraction both before and after on-pump aortic valve replacement. |
| format | Article |
| id | doaj-art-6cd6433f7aaa4bcda51c681eff4da27e |
| institution | Kabale University |
| issn | 2078-5658 2541-8653 |
| language | Russian |
| publishDate | 2023-07-01 |
| publisher | New Terra Publishing House |
| record_format | Article |
| series | Вестник анестезиологии и реаниматологии |
| spelling | doaj-art-6cd6433f7aaa4bcda51c681eff4da27e2025-08-20T03:56:32ZrusNew Terra Publishing HouseВестник анестезиологии и реаниматологии2078-56582541-86532023-07-0120461810.24884/2078-5658-2022-20-4-6-18611Increased NT-proBNP levels and cardiac ventricular function during aortic valve replacement (pilot study)I. A. Kozlov0L. A. Krichevskiy1V. Yu. Rybakov2Moscow Regional Research Clinical Institute named after M. F. VladimirskyS. S. Yudin City Clinical HospitalS. S. Yudin City Clinical HospitalThe objective was to study the relationship between the increased preoperative N-terminal segment of B-type natriuretic peptide precursor (NT-proBNP) blood levels and the parameters of the heart ventricles function, as well as the conditions for coronary perfusion of their myocardium before and after on-pump aortic valve replacement.Materials and methods. The study involved 27 patients aged 57.7±2.5 years who underwent aortic valve replacement. NT-proBNP blood level was determined before surgery. The level of NT-proBNP > 1000 pg/ml was considered increased. Invasive hemodynamics, including the data of the right ventricle thermodilution volumetry, and transesophageal echocardiography data were analyzed at the stages: the 1st – after anesthesia induction, the 2nd – at the end of surgery. Logistic regression and ROC analysis were used for data processing.Results. Preoperative blood levels of NT-proBNP > 1000 (3163.0[2507.25–7319]) pg/ml were recorded in 55.6% of patients. At the 1st stage, the biomarker increased level was associated with increased index of left ventricular end-systolic volume (OR 1.0955, 95% CI 1.0097–1.1885, p = 0.028, AUC 0.903), decreased left ventricular ejection fraction (OR 0, 9447, 95% CI 0.8949–0.9973, p = 0.040, AUC 0.753) and area contraction fraction (OR 0.8868, 95% CI 0.8086–0.9726, p = 0.011, AUC 0.890), increased mean pulmonary artery pressure (OR 1.1824, 95% CI 1.0020–1.3952, p = 0.047, AUC 0.722), and increased transpulmonary gradient (OR 1.4497, 95% CI 1.0103–2.0802, p = 0.044, AUC 0.810), increased right ventricular stroke work index (OR 1.5151, 95% CI 1.0319–2.2246, p = 0.034, AUC 0.761), and decreased coronary perfusion gradients of the left (OR 0.8961–0.9241, 95% CI 0.8229–0.9459 – 0.8630–0.9896, p = 0.012–0.024, AUC 0.793–0.861) and right (OR 0.9519, 95% CI 0.9136–0.9918, p = 0.019, AUC 0.847) ventricles. At the 2nd stage, NT-proBNP blood values > 1000 pg/ml were associated with impaired left ventricular function, decreased mean arterial pressure (OR 0.9066, 95% CI 0.8264–0.9946, p = 0.038, AUC 0.761), and the vasopressor and inotropic support (OR 8.4000, 95% CI 1.2584–56.0694, p = 0.028, AUC 0.710).Conclusions. Prior to aortic valve replacement, the blood level of NT-proBNP > 1000 pg/ml is associated with a moderate decrease in the left ventricular ejection fraction and area contraction fraction, an increased left ventricular end-systolic volume with a normal end-diastolic volume, an increased index of right ventricular stroke work in combination with moderately increased mean pulmonary artery pressure and increased transpulmonary gradient, as well as a decreased coronary perfusion gradients. At the end of operations, increased NT-proBNP blood level is associated with signs of impaired left ventricular contractility, a tendency to arterial hypotension, and the vasopressor and inotropic support. Increased preoperative NT-proBNP blood level are not associated with right ventricular volumes and ejection fraction both before and after on-pump aortic valve replacement.https://www.vair-journal.com/jour/article/view/825n-terminal segment of b-type natriuretic peptide precursornt-probnpaortic stenosison-pump aortic valve replacementcentral hemodynamicsright ventricular functioncoronary perfusion gradients |
| spellingShingle | I. A. Kozlov L. A. Krichevskiy V. Yu. Rybakov Increased NT-proBNP levels and cardiac ventricular function during aortic valve replacement (pilot study) Вестник анестезиологии и реаниматологии n-terminal segment of b-type natriuretic peptide precursor nt-probnp aortic stenosis on-pump aortic valve replacement central hemodynamics right ventricular function coronary perfusion gradients |
| title | Increased NT-proBNP levels and cardiac ventricular function during aortic valve replacement (pilot study) |
| title_full | Increased NT-proBNP levels and cardiac ventricular function during aortic valve replacement (pilot study) |
| title_fullStr | Increased NT-proBNP levels and cardiac ventricular function during aortic valve replacement (pilot study) |
| title_full_unstemmed | Increased NT-proBNP levels and cardiac ventricular function during aortic valve replacement (pilot study) |
| title_short | Increased NT-proBNP levels and cardiac ventricular function during aortic valve replacement (pilot study) |
| title_sort | increased nt probnp levels and cardiac ventricular function during aortic valve replacement pilot study |
| topic | n-terminal segment of b-type natriuretic peptide precursor nt-probnp aortic stenosis on-pump aortic valve replacement central hemodynamics right ventricular function coronary perfusion gradients |
| url | https://www.vair-journal.com/jour/article/view/825 |
| work_keys_str_mv | AT iakozlov increasedntprobnplevelsandcardiacventricularfunctionduringaorticvalvereplacementpilotstudy AT lakrichevskiy increasedntprobnplevelsandcardiacventricularfunctionduringaorticvalvereplacementpilotstudy AT vyurybakov increasedntprobnplevelsandcardiacventricularfunctionduringaorticvalvereplacementpilotstudy |