Key result
Preoperative plasma MR-proADM and NT-proBNP did not predict blood pressure fluctuations during PPGL resection, but were associated with perioperative cardiovascular events (OR 5.46 and OR 1.54).
Why the study?
Blood pressure fluctuations are common during PPGL resection despite adequate presurgical management, and the variability in blood pressure control remains largely unexplained.
Do preoperative plasma levels of MR-proADM and NT-proBNP predict blood pressure fluctuations during pheochromocytoma or sympathetic paraganglioma resection?
Cross-Sectional (n=126)
Do preoperative plasma levels of MR-proADM and NT-proBNP predict blood pressure fluctuations during pheochromocytoma or sympathetic paraganglioma resection?
Preoperative plasma MR-proADM and NT-proBNP do not predict blood pressure fluctuations during PPGL resection, though they may be associated with perioperative cardiovascular events.
BACKGROUND: Despite adequate presurgical management, blood pressure fluctuations are common during resection of pheochromocytoma or sympathetic paraganglioma (PPGL). To a large extent, the variability in blood pressure control during PPGL resection remains unexplained. Adrenomedullin and B-type natriuretic peptide, measured as MR-proADM and NT-proBNP, respectively, are circulating biomarkers of cardiovascular dysfunction. We investigated whether plasma levels of MR-proADM and NT-proBNP are associated with blood pressure fluctuations during PPGL resection. METHODS: Study subjects participated in PRESCRIPT, a randomized controlled trial in patients undergoing PPGL resection. MR-proADM and NT-proBNP were determined in a single plasma sample drawn before surgery. Multivariable linear and logistic regression analyses were used to explore associations between these biomarkers and blood pressure fluctuations, use of vasoconstrictive agents during surgery as well as the occurrence of perioperative cardiovascular events. RESULTS: A total of 126 PPGL patients were included. Median plasma concentrations of MR-proADM and NT-proBNP were 0.51 (0.41-0.63) nmol/L and 68.7 (27.9-150.4) ng/L, respectively. Neither MR-proADM nor NT-proBNP were associated with blood pressure fluctuations. There was a positive correlation between MR-proADM concentration and the cumulative dose of vasoconstrictive agents (03B2 0.44, P =0.001). Both MR-proADM and NT-proBNP were significantly associated with perioperative cardiovascular events (OR: 5.46, P =0.013 and OR: 1.54, P =0.017, respectively). CONCLUSIONS: plasma MR-proADM or NT-proBNP should not be considered as biomarkers for the presurgical risk assessment of blood pressure fluctuations during PPGL resection. Future studies are needed to explore the potential influence of these biomarkers on the intraoperative requirement of vasoconstrictive agents and the perioperative cardiovascular risk.
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Berends et al. (2021) conducted a cross-sectional in pheochromocytoma or sympathetic paraganglioma (PPGL) (n=126). MR-proADM and NT-proBNP was evaluated on blood pressure fluctuations. Preoperative plasma MR-proADM and NT-proBNP did not predict blood pressure fluctuations during PPGL resection, but were associated with perioperative cardiovascular events (OR 5.46 and OR 1.54).
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