Utility of NT-proBNP as an objective marker of postoperative heart failure after coronary artery bypass surgery: a prospective observational study

Huiqi Jiang, Jonas Holm, Örjan Friberg, Farkas Vanky, Mårten Vidlund, Bashir Tajik, Yanqi Yang, Rolf Svedjeholm, Huiqi Jiang, Jonas Holm, Örjan Friberg, Farkas Vanky, Mårten Vidlund, Bashir Tajik, Yanqi Yang, Rolf Svedjeholm

Abstract

Background: Postoperative heart failure (PHF) is the main cause for mortality after cardiac surgery but unbiased evaluation of PHF is difficult. We investigated the utility of postoperative NT-proBNP as an objective marker of PHF after coronary artery bypass surgery (CABG).

Methods: Prospective study on 382 patients undergoing isolated CABG for acute coronary syndrome. NT-proBNP was measured preoperatively, the first (POD1) and third postoperative morning (POD3). A blinded Endpoints Committee used prespecified criteria for PHF. Use of circulatory support was scrutinized.

Results: After adjusting for confounders PHF was associated with 1.46 times higher NT-proBNP on POD1 (p = 0.002), 1.54 times higher on POD3 (p < 0.0001). In severe PHF, NT-proBNP was 2.18 times higher on POD1 (p = 0.001) and 1.81 times higher on POD3 (p = 0.019). Postoperative change of NT-proBNP was independently associated with PHF (OR 5.12, 95% CI 1.86-14.10, p = 0.002). The use of inotropes and ICU resources increased with incremental quartiles of postoperative NT-proBNP.

Conclusions: Postoperative NT-proBNP can serve as an objective marker of the severity of postoperative myocardial dysfunction. Due to overlap in individuals, NT-proBNP is useful mainly for comparisons at cohort level. As such, it provides a tool for study purposes when an unbiased assessment of prevention or treatment of PHF is desirable.

Trial registration: ClinicalTrials.gov Identifier: NCT00489827 https://ichgcp.net/clinical-trials-registry/NCT00489827?term=glutamics&draw=2&rank=1 .

Keywords: Coronary artery bypass surgery; Heart failure; Natriuretic peptide; Postoperative care.

Conflict of interest statement

The authors declare that they have no competing interests.

© 2021. The Author(s).

Figures

Fig. 1
Fig. 1
Perioperative NT-proBNP levels in patients without postoperative heart failure (PHF), with PHF and severe PHF. Data given as medians with interquartile range. Mann-Whitney U test was performed and p < 0.05 was considered significant, indicated by*
Fig. 2
Fig. 2
Receiver operating characteristics (ROC) to evaluate discrimination of postoperative NT-proBNP for PHF. Left panel (a) demonstrates discrimination of NT-proBNP on POD1 for PHF (AUC = 0.70; 95% CI 0.61–0.79; p < 0.0001, best cut-off 1836 ng/L with a sensitivity of 90% and a specificity of 46%, n = 320). Right panel (b) demonstrates discrimination of NT-proBNP on POD3 for PHF (AUC = 0.70; 95% CI 0.60–0.81; p < 0.0001, best cut-off 6065 ng/L with a sensitivity of 57% and a specificity of 79%, n = 325). AUC area under curve, CI confidence interval, POD1 postoperative day 1, POD3 postoperative day 3
Fig. 3
Fig. 3
Receiver operating characteristics (ROC) to evaluate discrimination of postoperative NT-proBNP for severe PHF. Left panel (a) demonstrates discrimination of NT-proBNP on POD1 for severe PHF (AUC = 0.86; 95% CI 0.76–0.95; p = 0.001, best cut-off 4574 ng/L with a sensitivity of 71%, n = 320). Right panel (b) demonstrates discrimination of NT-proBNP on POD3 for severe PHF (AUC = 0.79; 95% CI 0.55–1.00; p = 0.015, best cut-off 6065 ng/L with a sensitivity of 83% and a specificity of 77%, n = 325). AUC area under curve, CI confidence interval, POD1 postoperative day 1, POD3 postoperative day 3

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