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Postoperative plasma levels of NTproBNP do not reflect a short-lasting low-cardiac output state after coronary artery bypass surgery

M. Heringlake1, M. Wernerus1, J. Grünefeld1, J. Schön1, L. Dibbelt2, T. Hanke3, M. Bechtel3, M. Misfeld3, F. Eberhardt4, H. Heinze1
1Department of Anesthesiology, 2Institute of Clinical Chemistry, 3Department of Cardiac and Thoracic Vascular Surgery, 4Medical Clinic II, University of Lübeck, Lübeck, Germany
[Applied Cardiopulmonary Pathophysiology 12: 47-52, 2008]

Abstract

Introduction: The N-terminal-prohormone of the B-type-natriuretic-peptide (NTproBNP) is an accepted marker of acute heart failure in medical patients. It is not known if the plasma levels of this peptide may also be useful to detect a low-cardiac-output-syndrome (LCOS) in postoperative cardiac surgery patients.
Materials and methods: A posthoc analysis of a prospective, randomized trial investigating the effects of different inotropes on metabolism and renal function in patients presenting with a LCOS upon ICU-admission in comparison with a group of patients not needing inotropes after coronary artery bypass grafting (CABG) surgery was performed. LCOS was defined as a cardiac index (CI) < 2.2 l/min/m2 despite optimization of filling pressures and mean arterial pressure. 18 patients fulfilled the LCOS-criteria (LCOS-group) and underwent 14h treatment with adrenaline or milrinone aimed to achieve a CI > 3.0 l/min/m2, 20 patients served as controls (CON-group). Plasma levels of NTproBNP and hemodynamics were determined at 0, 2, 6, 10, 14, and 48 hours after ICU-admission.
Results: Baseline NTproBNP levels in the LCOS- and the CON group were 462 ± 404 pg/ml and 296 ± 259 pg/ml, and increased to 2411 ± 1592 pg/ml and 2321 ± 1375 pg/ml respectively, at t=48h. No significant between-group differences in NTproBNP were observed. CI in the LCOS-group was 1.9 ± 0.2 l/min/m2 at t0, increased to 2.9 ± 0.5 l/min/m2 at t2, and was maintained at 3.0 to 3.4 l/min/m2 thereafter. Cardiac index in the CON-group was 3.1±0.4 l/min/m2 at t0 (p<0.001 vs. LCOS) and increased to 3.8 ± 1.0 l/min/m2 (p=0.019) during the treatment period.
Conclusions: Postoperative plasma levels of NTproBNP do not discriminate between patients with a short-lasting LCOS or a normal myocardial function. This questions the usefulness of determining plasma NTproBNP levels for guiding hemodynamic treatment in the immediate postoperative period after CABG surgery.

Key words: natriuretic peptides, low-cardiac output syndrom, acute heart failure, cardiac surgery


Address for corresponding: Matthias Heringlake, M.D., Department of Anesthesiology, University of Lübeck, Ratzeburger Allee 160, D-23538 Lübeck, Germany, E-Mail: Öffnet ein Fenster zum Versenden einer E-MailHeringlake@bitte-keinen-spamt-online.de



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