Prognostic significance of the biomarker NT-proBNP in the surgical treatment of aortic stenosis (pilot study)
The objective was to study the relationship between the preoperative blood levels of the N-terminal segment of B-type natriuretic peptide precursor (NT-proBNP) and ultrasound and thermodilution indicators of cardiac function before and after on-pump surgery for aortic stenosis, as well as to evaluat...
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New Terra Publishing House
2023-06-01
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| Series: | Вестник анестезиологии и реаниматологии |
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| Online Access: | https://www.vair-journal.com/jour/article/view/810 |
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| author | I. A. Kozlov L. A. Krichevsky V. Yu. Rybakov |
| author_facet | I. A. Kozlov L. A. Krichevsky V. Yu. Rybakov |
| author_sort | I. A. Kozlov |
| collection | DOAJ |
| description | The objective was to study the relationship between the preoperative blood levels of the N-terminal segment of B-type natriuretic peptide precursor (NT-proBNP) and ultrasound and thermodilution indicators of cardiac function before and after on-pump surgery for aortic stenosis, as well as to evaluate the prognostic significance of the biomarker in relation to postoperative myocardial dysfunction.Materials and methods. The study involved 27 patients aged 57.7±2.5 years who underwent aortic valve replacement. NT-proBNP level was determined before surgery. The indicators of invasive hemodynamics and transesophageal echocardiography were analyzed at stages: I – after anesthesia induction, II – at the end of surgery. Correlation analysis, logistic regression and ROC analysis were used.Results. The preoperative NT-proBNP level was 2002.0 [540.8–4001.5] pg/ml. At I stage, NT-proBNP correlated with mean pulmonary artery pressure (rho = 0.468; p = 0.014), indices of left ventricular function (rho = –0.509; p = 0.007), end-diastolic and end-systolic volumes (rho = 0.737–0.757; p < 0.0001), as well as ejection fraction (rho = –0.556; p = 0.004) and area contraction fraction (rho = –0.783; p < 0.0001). At II stage, the level of NT-proBNP > 2000 pg/ml was a predictor of the left ventricular area contraction fraction < 50% (OR 1.0011, 95% CI 1.0002–1.0020, p = 0.028, AUC 0.799) , the left ventricular end-systolic area index > 9 cm2/m2 (OR 1.0007, 95% CI 1.0001–1.0013, p = 0.027, AUC 0.886), vasoactive-inotropic score > 10 (OR 1.0006, 95% CI 1.0001–1.0012, p = 0.032, AUC 0.876), duration of sympathomimetic therapy > 24 h (OR 1.0001, 95% CI 1.0000–1.0003, p = 0.049, AUC 0.889).Conclusions. NT-proBNP blood level was increased in 66.7% of patients with aortic stenosis before surgery. Moreover, the biomarker level directly correlates with the mean pulmonary artery pressure, the indices of end-diastolic and end-systolic volumes, end-diastolic and end-systolic areas of the left ventricle, and it inversely correlates with the left ventricular stroke work index, ejection fraction and left ventricular area contraction fraction. The preoperative NT-proBNP level was a predictor of the postoperative decrease to the pathological level of the ejection fractions and left ventricular area contraction, an increase in the left ventricular end-systolic area index, intensive and prolonged sympathomimetic therapy. Myocardial dysfunctions were most pronounced in patients with biomarker levels above 2000 pg/ml. |
| format | Article |
| id | doaj-art-d5ef9080feae4f5e8a0aa7827dab9567 |
| institution | Kabale University |
| issn | 2078-5658 2541-8653 |
| language | Russian |
| publishDate | 2023-06-01 |
| publisher | New Terra Publishing House |
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| series | Вестник анестезиологии и реаниматологии |
| spelling | doaj-art-d5ef9080feae4f5e8a0aa7827dab95672025-08-20T03:42:56ZrusNew Terra Publishing HouseВестник анестезиологии и реаниматологии2078-56582541-86532023-06-0120361910.24884/2078-5658-2023-20-3-6-19599Prognostic significance of the biomarker NT-proBNP in the surgical treatment of aortic stenosis (pilot study)I. A. Kozlov0L. A. Krichevsky1V. Yu. Rybakov2M.F. Vladimirsky Moscow Regional Research Clinical InstituteS.S. Yudin City Clinical HospitalS.S. Yudin City Clinical HospitalThe objective was to study the relationship between the preoperative blood levels of the N-terminal segment of B-type natriuretic peptide precursor (NT-proBNP) and ultrasound and thermodilution indicators of cardiac function before and after on-pump surgery for aortic stenosis, as well as to evaluate the prognostic significance of the biomarker in relation to postoperative myocardial dysfunction.Materials and methods. The study involved 27 patients aged 57.7±2.5 years who underwent aortic valve replacement. NT-proBNP level was determined before surgery. The indicators of invasive hemodynamics and transesophageal echocardiography were analyzed at stages: I – after anesthesia induction, II – at the end of surgery. Correlation analysis, logistic regression and ROC analysis were used.Results. The preoperative NT-proBNP level was 2002.0 [540.8–4001.5] pg/ml. At I stage, NT-proBNP correlated with mean pulmonary artery pressure (rho = 0.468; p = 0.014), indices of left ventricular function (rho = –0.509; p = 0.007), end-diastolic and end-systolic volumes (rho = 0.737–0.757; p < 0.0001), as well as ejection fraction (rho = –0.556; p = 0.004) and area contraction fraction (rho = –0.783; p < 0.0001). At II stage, the level of NT-proBNP > 2000 pg/ml was a predictor of the left ventricular area contraction fraction < 50% (OR 1.0011, 95% CI 1.0002–1.0020, p = 0.028, AUC 0.799) , the left ventricular end-systolic area index > 9 cm2/m2 (OR 1.0007, 95% CI 1.0001–1.0013, p = 0.027, AUC 0.886), vasoactive-inotropic score > 10 (OR 1.0006, 95% CI 1.0001–1.0012, p = 0.032, AUC 0.876), duration of sympathomimetic therapy > 24 h (OR 1.0001, 95% CI 1.0000–1.0003, p = 0.049, AUC 0.889).Conclusions. NT-proBNP blood level was increased in 66.7% of patients with aortic stenosis before surgery. Moreover, the biomarker level directly correlates with the mean pulmonary artery pressure, the indices of end-diastolic and end-systolic volumes, end-diastolic and end-systolic areas of the left ventricle, and it inversely correlates with the left ventricular stroke work index, ejection fraction and left ventricular area contraction fraction. The preoperative NT-proBNP level was a predictor of the postoperative decrease to the pathological level of the ejection fractions and left ventricular area contraction, an increase in the left ventricular end-systolic area index, intensive and prolonged sympathomimetic therapy. Myocardial dysfunctions were most pronounced in patients with biomarker levels above 2000 pg/ml.https://www.vair-journal.com/jour/article/view/810n-terminal segment of b-type natriuretic peptide precursornt-probnpaortic stenosison-pump aortic valve replacementtransesophageal echocardiography |
| spellingShingle | I. A. Kozlov L. A. Krichevsky V. Yu. Rybakov Prognostic significance of the biomarker NT-proBNP in the surgical treatment of aortic stenosis (pilot study) Вестник анестезиологии и реаниматологии n-terminal segment of b-type natriuretic peptide precursor nt-probnp aortic stenosis on-pump aortic valve replacement transesophageal echocardiography |
| title | Prognostic significance of the biomarker NT-proBNP in the surgical treatment of aortic stenosis (pilot study) |
| title_full | Prognostic significance of the biomarker NT-proBNP in the surgical treatment of aortic stenosis (pilot study) |
| title_fullStr | Prognostic significance of the biomarker NT-proBNP in the surgical treatment of aortic stenosis (pilot study) |
| title_full_unstemmed | Prognostic significance of the biomarker NT-proBNP in the surgical treatment of aortic stenosis (pilot study) |
| title_short | Prognostic significance of the biomarker NT-proBNP in the surgical treatment of aortic stenosis (pilot study) |
| title_sort | prognostic significance of the biomarker nt probnp in the surgical treatment of aortic stenosis pilot study |
| topic | n-terminal segment of b-type natriuretic peptide precursor nt-probnp aortic stenosis on-pump aortic valve replacement transesophageal echocardiography |
| url | https://www.vair-journal.com/jour/article/view/810 |
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