Original article
B-Type Natriuretic Peptide as a Predictor of Postoperative Heart Failure After Aortic Valve Replacement

https://doi.org/10.1053/j.jvca.2008.11.006Get rights and content

Objective

B-type natriuretic peptide (BNP) has been established as a biomarker for heart failure. The objective was to evaluate BNP measured on arrival in the intensive care unit (ICU) as a predictor for heart failure defined as need for inotropic support or IABP beyond 24 hours postoperatively after aortic valve replacement.

Design

A prospective, observational study.

Setting

A cardiothoracic surgery unit at a tertiary level hospital.

Participants

One hundred sixty-one patients undergoing aortic valve replacement.

Measurements and Main Results

Two levels of BNP were evaluated: the median (BNP >133 pg/mL) and a cutoff (BNP >82 pg/mL) based on receiver-operating characteristic (ROC) analysis. Uni- and multivariate analysis were performed to identify predictors of postoperative heart failure. Patients with postoperative heart failure (n = 37) showed a more than 10-fold increase in 30-day mortality (8.1%, 3/37) compared with patients without postoperative heart failure (0.8%, 1/124) (p = 0.038). Elevated postoperative BNP levels were identified as an independent predictor of postoperative heart failure: BNP >82 pg/mL (p = 0.004) and BNP >133 pg/mL (p = 0.013). The area under the ROC curve for BNP as a predictor of postoperative heart failure was 0.69.

Conclusion

Postoperative heart failure after aortic valve replacement is still a very serious condition with increased early mortality. The results of the present study suggest that an elevated BNP level on arrival in the ICU is an independent predictor of postoperative heart failure after aortic valve replacement. In the authors' opinion, an increased BNP level on arrival in the ICU may support early diagnosis and allow optimal management of heart failure after aortic valve replacement.

Section snippets

Methods

Between September 2006 and October 2007, 161 patients undergoing AVR in the Department of Cardiothoracic Surgery at Lund University Hospital, Sweden, were included in the study. Exclusion criteria were aortic dissection, surgery on the aortic arch, and procedures including deep hypothermia with circulatory arrest. Valve pathology was determined by echocardiography and classified as degenerative calcification (n = 136), aortic insufficiency (n = 15), active endocarditis (n = 6), and structural

Results

The 30-day mortality was significantly higher in patients with heart failure (group II, 8.1%, 3/37) than in patients without postoperative heart failure (group I, 0.8%, 1/124; p = 0.038). The cause of death was cardiac-related in all patients (circulatory collapse, 4/4). The distribution of the BNP levels in the study population is presented in Figure 2. Patients in group 2 had a mean BNP value on arrival in the ICU (D0) of 379 ± 417 pg/mL (median 270 pg/mL ranging from 22-1,940), whereas the

Discussion

Postoperative HF after AVR still remains an important predictor of poor outcome.2, 3, 4 The present data showed that the 30-day mortality was more than 10-fold increased (8.1% v 0.8%) in patients with postoperative heart failure. The association between postoperative HF and 30-day mortality emphasizes the importance of early diagnosis and the initiation of adequate therapy in the ICU. BNP has been shown to be a reliable and easily accessible biomarker for diagnosing heart failure.8, 12

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