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December 1, 2024Acta Anaesthesiologica BelgicaOpen Access

Higher preoperative NT-proBNP correlates with reduced LV GLS and LVEF in severe aortic stenosis.

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Why the study?

Apart from NT-proBNP, the relationships between emerging biomarkers and ventricular systolic or diastolic dysfunction remain poorly investigated in patients eligible for cardiac surgery.

Do preoperative plasma levels of NT-proBNP, sST2, Galectin 3, and GDF-15 correlate with and predict systolic or diastolic dysfunction in patients with severe aortic stenosis scheduled for surgical aortic valve replacement?

Population

179 patients undergoing aortic valve replacement for severe aortic stenosis

Comparison

Plasma levels of NT-proBNP, sST2, Galectin 3, and GDF-15 evaluated against echocardiographic measurements

Design

Exploratory analysis of a prospective observational trial

Key result

Preoperative plasma levels of NT-proBNP significantly correlated with left ventricular global longitudinal strain (ρ=-0.40) and ejection fraction (ρ=-0.31) in patients with severe aortic stenosis.

Authors

MDM DesenfantPAPhilippe AmabiliGHGrégory Hans

Discussion

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Overview

May inform preoperative LV assessment in severe AS; leaves open incremental value over echocardiography.

Study Design

Type

Observational (n=179)

Multicenter

No

Structured PICO

Do preoperative plasma levels of NT-proBNP, sST2, Galectin 3, and GDF-15 correlate with and predict systolic or diastolic dysfunction in patients with severe aortic stenosis scheduled for surgical aortic valve replacement?

P
Population
179 adult patients with severe aortic stenosis scheduled for elective single aortic valve replacement (with or without coronary artery bypass grafts), median age 73, 34.1% female. Exclusion criteria: inability to consent, previous cardiac surgery, eGFR ≤ 30 ml/min, active endocarditis, atrial fibrillation, liver cirrhosis, and implanted permanent pacemaker.
I
Intervention
Preoperative plasma measurement of NT-proBNP, soluble ST2 (sST2), Galectin 3, and growth differentiation factor-15 (GDF-15)
O
Outcome
Monotonic interactions (Spearman correlation coefficient) between the biomarkers and various echocardiographic measurements performed during pre-cardiopulmonary bypass transesophageal echosurrogate

Main Result

Effect estimate: ρ=-0.40

p-value: p=<0.001

In patients with severe aortic stenosis undergoing surgical valve replacement, NT-proBNP correlates with left ventricular systolic and diastolic dysfunction, whereas newer biomarkers like sST2, Galectin 3, and GDF-15 add little predictive value.

Limitations

  • Included only patients at an advanced stage of the disease with elevated baseline biomarker values.
  • Echocardiographic measurements were performed using transesophageal echo while patients were anesthetized and under positive pressure ventilation.
  • Underpowered for detecting right ventricular systolic dysfunction due to low event rate.
  • No formal sample size estimation was performed a priori as it was a secondary analysis.
  • Patients were at an advanced stage of disease with elevated baseline biomarker values
  • Echocardiographic measurements were performed using transesophageal echo while patients were anesthetized and under positive pressure ventilation
  • Underpowered for detecting right ventricular dysfunction, which is a late event in aortic stenosis
  • No formal sample size estimation was performed a priori as it was a secondary analysis

Cite This Study

Desenfant et al. (2024) conducted an observational in Severe aortic stenosis (n=179). Preoperative plasma biomarkers (NT-proBNP, sST2, Galectin 3, GDF-15) was evaluated on Correlation between NT-proBNP and global longitudinal strain (GLS) (ρ=-0.40, p=<0.001). Preoperative plasma levels of NT-proBNP significantly correlated with left ventricular global longitudinal strain (ρ=-0.40) and ejection fraction (ρ=-0.31) in patients with severe aortic stenosis.

synapsesocial.com/papers/6a17e77356b3e2ada412c6fehttps://doi.org/10.56126/76.s1.12
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