The objective : to study the relationship between the preoperative blood levels of the N-terminal segment of B-type natriuretic peptide precursor (NT-proBNP) and echocardiographic and pulmonary artery catheter (PAC) data before and after on-pump coronary artery bypass grafting (CABG), and to evaluate the biomarker as a predictor of postoperative myocardial dysfunction. Material and methods . The study involved 63 patients aged 5139–64 years with ischemic heart disease who underwent CABG. NT-proBNP blood level was determined before surgery. PAC and transesophageal echocardiography (TEE) data were analyzed at the stages: I – after anesthesia induction, II – at the end of surgery. Correlation analysis, logistic regression with calculation of odds ratio (OR) and 95% confidence interval (95% CI) and ROC analysis with calculation of area under ROC curve (AUC) were used. Results. The median preoperative NT-proBNP blood level was 418.3225.5–950.45 pg/mL. At stage I, NT-proBNP moderately correlated with mean and wedge pulmonary artery pressures, as well as with TEE parameters of the left ventricle (LV) sizes and function. At stage II, the biomarker moderately correlated only with TEE parameters. NT-proBNP >579 pg/mL was a predictor of LV area contraction fraction (LVACF) 605 pg/mL was a predictor of LV end-systolic area index (LVESAI) >9 cm2 / m2 (OR1.0015, 95% CI 1.0004–1.0026, p=0.008, AUC0.834) at the end of surgery. NT-proBNP10 (OR1.0016, 95% CI 1.0005–1.0026, p=0.003, AUC0.808), intra-aortic balloon pumping (IABP) (OR1.0019, 95% CI 1.0007–1.0030, p=0.001, AUC0.914) and intensive care unit length of stay >24 hours (OR1.0020, 95% CI 1.0007–1.0032, p=0.002, AUC0.771). NTproBNP >953 pg/mL was a predictor of the refractory heart failure (RHF) (OR1.0017, 95% CI 1.0006–1.0027, p=0.003, AUC0.866). Conclusion. In 50.8% of patients before on-pump CABG, NT-proBNP blood level exceeded the upper limit of normal and varied within the range of 355–3232 pg/ml. NT-proBNP values moderately correlated with perioperative TEE parameters. There were no persistent correlations with PAC data. Preoperative NT-proBNP values of about 600 pg/mL were predictors of LVESAI >9 cm2 /m2 (AUC0,834) and LVACF 950 pg/mL was a predictor of RHF after on-pump CABG (AUC0.866).
Ia et al. (Mon,) studied this question.