Key Points
- To evaluate the prognostic significance of perioperative B-type natriuretic peptide (BNP) and cardiac troponin I concentrations for postoperative cardiac dysfunction and 1-year mortality in cardiac surgery patients.
- Prospective observational study including 92 consecutive adult patients undergoing elective coronary artery bypass (n=43) or valve surgery (n=49) with cardiopulmonary bypass.
- Plasma concentrations of BNP and cardiac troponin I were measured before surgery (day 0) and on postoperative day 1.
- Outcomes evaluated included postoperative cardiac dysfunction (low cardiac output, hemodynamic instability requiring inotropes >24 hours, or heart failure up to day 5) and 1-year mortality.
- Day 1 postoperative BNP and cardiac troponin I concentrations, along with preoperative NYHA class, independently predicted postoperative cardiac dysfunction.
- Simultaneous elevation of both biomarkers was associated with a 12-fold increased risk of postoperative heart failure, outperforming either marker alone.
- Age, low preoperative left ventricular ejection fraction (LVEF), and day 1 BNP >352 pg/mL were associated with 1-year mortality in univariate analysis, but only LVEF remained significantly associated with 1-year survival in multivariate analysis.
Structured PICO
Do perioperative measurements of BNP and cardiac troponin I predict postoperative cardiac dysfunction and 1-year mortality in patients undergoing elective cardiac surgery?
PPopulation92 consecutive adult patients undergoing elective coronary artery (n=43) or valve surgery (n=49) with cardiopulmonary bypass at a university hospital.
IInterventionMeasurement of B-type natriuretic peptide (BNP) and cardiac troponin I concentrations before surgery (day 0) and at day 1 after surgery.
OOutcomePostoperative cardiac dysfunction (defined as low cardiac output or hemodynamic instability requiring inotropic support for >24 hrs or congestive heart failure until day 5).composite
Simultaneous measurement of day 1 postoperative BNP and cardiac troponin I strongly predicts postoperative cardiac dysfunction, improving early risk assessment after cardiac surgery.