Abstract
BACKGROUND:
After coronary artery bypass graft (CABG) surgery, heart failure is still major problem. The valuable marker for it is needed.
AIM:
Evaluating the role of serial NT-proBNP level in prognosis and follow-up treatment of acute heart failure after CABG surgery.
METHODS:
The prospective, analytic study evaluated 107 patients undergoing CABG surgery at Ho Chi Minh Heart Institute from October 2012 to June 2014. Collecting data was done at pre- and post-operative days with measuring NT-proBNP levels on the day before operation, 2 hours after surgery, every next 24 h until the 5th day, and in case of acute heart failure occurred after surgery.
RESULTS:
On the first postoperative day (POD1), the NT-proBNP level demonstrated significant value for AHF with the cut-off point = 817.8 pg/mL and AUC = 0.806. On the second and third postoperative day, the AUC value of NT- was 0.753 and 0.751. It was statistically significant in acute heart failure group almost at POD 1 and POD 2 when analyzed by the doses of dobutamine, noradrenaline, and adrenaline (both low doses and normal doses).
CONCLUSION:
Serial measurement of NT-proBNP level provides useful prognostic and follow-up treatment information in acute heart failure after CABG surgery.
Keywords: N-terminal pro-B-type natriuretic peptide (NT-proBNP), serial measurements, acute heart failure (AHF), coronary artery bypass graft surgery (CABG), prognosis, follow-up treatment
Introduction
Acute heart failure emerged as the primary cause of mortality after heart surgery in general and CABG surgery in particular [1]. It needs to early recognize before operation that helps clinicians consider patients who had heart failure into subgroups and allocate resources to maximize benefit from treatment and minimize risks such as adverse events. To predict early outcomes from cardiac surgery, both clinical tools (scoring systems) and biochemical tests were used. The two most common scoring systems were the EuroSCORE [2] and the Parsonnet score [3]. Although frequently used, it also had some limitations [4], [5]. To resolve, some biochemical tests were considered. Among that, NT-proBNP was emerged as one of the promise markers in heart disease, especially in heart failure [6]. It was used to predict postoperative outcomes in heart surgery in both early [7] and long-term effects [8]. The Canadian guideline recommended using it in persons with HF as a prognostic factor [9].
The guideline of ESC also remarked NT-proBNP as one of prognostic factors [10]. Moreover, in CABG surgery, it independently predicted postoperative outcome [11]. In combination with existing clinical tools such as EuroSCORE II, it showed more accuracy than using it alone [12].
Besides predictive ability before cardiac surgery [13], NT-proBNP levels contribute a valuable role in heart failure management [14] evenly in acute or unstable state [15]. Elevating NT-proBNP levels in these situations was associated with poor clinical outcomes [16], [17]. To optimize medical therapy, serial NT-proBNP measurement was used in stable CHF patients [18]. But in acute heart failure after CABG surgery, data of this biochemical marker were too limited.
Therefore, this study aimed to evaluate the serial NT-proBNP level that could provide prognostic and follow-up treatment information of acute heart failure after CABG surgery.
Materials and Methods
We conducted this prospective study on 107 patients who underwent CABG surgery at Ho Chi Minh Heart Institute from October 2012 to June 2014. Inclusion criteria included patients with established diagnoses of coronary artery stenosis based on angiography; aged 18 and older; consultation of internal medicine and surgery, and indication for CABG according to the recommendation American Internal Medicine Association (ACC/AHA/ACP /ASIM).
The exclusion criteria were: aged <18; damage of 1 or 2 branches of coronary artery; overall 50 - 60% of coronary artery stenosis with excepting main body; < 50% diameter of coronary artery stenosis; concomitant cardiac surgery such as valve surgery and septal surgery ; renal function insufficiency (eGFR <30 ml/min/1.73m2).
Monitoring
Chronic heart failure (CHF) before surgery was diagnosed according to the Framingham criteria, while postoperative diagnosis of acute heart failure (AHF) was followed the guidelines of Viet Nam Heart Association 2015 with staging A, B, C and D according to ACC/AHA and grading according to NYHA. Indexes in heart failure were recorded in echocardiography. The main prognosis factor of heart failure after surgery were EuroSCORE and the level of serial NT-proBNP. NT-proBNP level was quantified at the Department of Biochemistry at Ho Chi Minh Heart Institute, using the electrochemiluminescence immunoassay (ECLIA). The optimal cutting points of NT-proBNP to determine acute heart failure for ages younger than 50, from 50 to 75 and older than 75 years are 450, 900 and 1800 pg/ml, respectively. The NT-proBNP-independent age cut point less than 300 pg/ml had a negative diagnostic value to rule out acute heart failure at 98%.Collecting time was noted as following: B0: the day before surgery; B1: 2 hours after surgery; B2, B3, B4, B5 were collected at 8 a.m on days 2, 3, 4, 5 after surgery; Bx: at the time of expression of cardiac dysfunction (continuous monitoring of cardiac index on the Flo-Trac system) or when the patient presents with acute heart failure.
We also recorded data about dosage and using time of dobutamine, noradrenaline, and adrenaline in collecting time after surgery to follow-up treatment. Collecting time was noted as following: N0: the day before surgery; N1: 2 hours after surgery; N2, N3, N4, N5 were collected at 8 a.m on days 2, 3, 4, 5 after surgery. In addition, follow-up at times when patients showed cardiac impairment or when acute heart failure occurred.
Statistical analysis
Statistical analysis was performed by Epidata 6 and STATA version 14.0 software.
Descriptive analysis presented as mean ± standard deviation (95% confidence interval). Testing t-Student/Mann-Withney U test/Wilcoxon/ANOVA and Chi-square/ Fisher’s exact test, Kolmogorov test, Person correlation, single and multivariate linear regression methods used in the study. p-value < 0.05 was known as statistically significant.
Results
Out of 107 patients, 67.3% was male. Medical history was chest pain (98.1%), hypertension (77.6%), myocardial ischemia (77.6%), heart failure (28.0%), diabetes (24.3%), myocardial infarction (9.4%), dyslipidemia (7.5%), arrhythmias (4.7%), COPD (3.7%), and renal failure (1.9%). Demographics of CHF before surgery and AHF after surgery showed in Table 1.
Table 1.
Demographics of chronic heart failure before surgery and acute heart failure after surgery
| Pre-operative condition | Post-operative condition | |||
|---|---|---|---|---|
| Without AHF | AHF | Total | p-value | |
| Without CHF | 64 (78.1 %) | 7 (28.0 %) | 71 (66.4 %) | < 0.0001 |
| CHF | 18 (21.9 %) | 18 (72.0 %) | 36 (33.6 %) | < 0.0001 |
| Total | 82 (76.6 %) | 25 (23.4 %) | 107 (100%) | < 0.0001 |
Note: CHF: Chronic heart failure; AHF: Acute heart failure.
On the first postoperative day (POD1), the NT-proBNP level demonstrated significant value for AHF in patients undergoing CABG surgery with the cut-off point = 817.8 pg/mL and AUC = 0.806 (95% CI = 0.71 to 0.90; p<0.0001; sensitivity = 70%; and specificity = 80.5%). The values of NTproBNP for AHF on the second and third postoperative days (POD 2 and POD3) showed detail in Table 2.
Table 2.
Cut-off values of NT-proBNP according to Euro-score
| Post-operative day (POD) | Cut-off value | Sensitivity | Specificity | AUC (95% CI) | Youden – Index |
|---|---|---|---|---|---|
| POD 1 | 817.8 | 70.0 % | 80.5 % | 0.806 (0.71 – 0.90) | 0.505 |
| POD 2 | 2,516 | 66.7 % | 77.9 % | 0.753 (0.64 – 0.87) | 0.446 |
| POD 3 | 3,556 | 60.0 % | 81.6 % | 0.751 (0.64 – 0.86) | 0.416 |
Note: AUC: Area under the curve; CI: Confidence Interval.
Table 3 performed detail analysis of NT-proBNP cut-off value according to EuroSCORE.
Table 3.
Detail analysis of cut-off value of NT-proBNP according to EuroSCORE
| EuroSCORE | Cut-off NT-proBNP | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| L and I risk | High risk | Indexes | ≤ Cut-off | > Cut-off | Indexes | ||||||||
| Sen | Spe | Acc | P-value | Sen | Spe | Acc | P-value | ||||||
| Pre-operative Cut-off (508.8 pg/ml) | Without CHF (71) | 58 (81.7) | 13(18.3) | 47.2 | 81.7 | 70.1 | 0.002 | 56 (78.9) | 15 (21.1) | 80.6 | 78.9 | 79.44 | 0.000 |
| CHF (36) | 19 (52.8) | 17 (47.2) | 7 (19.4) | 29 (80.6) | |||||||||
| POD 1 Cut-off (871.8 pg/ml) | No AHF (94) | 73 (77.7) | 21 (22.3) | 77.7 | 69.2 | 76.64 | 0.002 | 70 (74.5) | 24 (25.5) | 74.5 | 92.3 | 76.64 | 0.000 |
| AHF (13) | 4 (30.8) | 9 (69.2) | 1 (7.7) | 12 (92.3) | |||||||||
| POD 2 Cut-off (2516 pg/ml) | No AHF (98) | 74 (75.5) | 24(24.5) | 75.5 | 66.7 | 74.8 | 0.014 | 68(69.4) | 30(30.6) | 69.4 | 77.8 | 70.1 | 0.008 |
| AHF (9) | 3 (33.3) | 6 (66.7) | 2(22.2) | 7 (77.8) | |||||||||
| POD 3 Cut-off (3556 pg/ml) | Without AHF(104) | 76(73.1) | 28(26.9) | 66.7 | 73.1 | 72.9 | 0.189 | 74(71.8) | 29(28.2) | 100 | 71.8 | 72.6 | 0.026 |
| AHF (3) | 1 (33.3) | 2 (66.7) | 0 (0) | 3 (100) | |||||||||
Note: Sensitivity = Sen; Specificity = Spe ;Accurac = ACC , POD: Postoperative day; CHF: Chronic heart failure; AHF: Acute heart failure; Low and Intermediate risk = L and I risk.
To follow-up treatment, the general dosage and using time of inotrope was shown in Table 4.
Table 4.
Dosage and using time of inotrope (μg/kg/min)
| Factors | Post-operative condition | p-values | ||
|---|---|---|---|---|
| Without AHF (n=82) | AHF (n=25) | |||
| Noradrenalin | Dosage | 0.85 ± 1.59 | 0.14 ± 0.12 | 0.75f |
| Using time | 43.1 ± 28.9 | 112.9 ± 37.5 | 0.000c | |
| Dobutamine | Dosage | 3.32 ± 1.82 | 6.25 ± 2.47 | 0.000f |
| Using time | 29.1 ± 28.2 | 101.1 ± 47.3 | 0.000f | |
| Adrenalin | Dosage | 0.026 ± 0.048 | 0.15 ± 0.15 | 0.000f |
| Using time | 16.6 ± 30.7 | 82.9 ± 55.6 | 0.000f | |
Note: AHF: Acute heart failure.
More detail showed in Table 5 (dobutamine), table 6 (noradrenaline), and table 7 (adrenaline). The level of NT-proBNP level in AHF group was statistically significant compared to the without AHF group at POD 1 and POD 2 when analyzed by the normal doses of dobutamine. In low doses, it just showed statistically significant at POD 2 (Table 5). In AHF group it was statistically significant compared to the without AHF group at POD 1 and POD 2 when analyzed by the low doses of noradrenaline. In low doses, it did not show statistically significant at POD all three days after surgery (Table 6).
Table 5.
Level of serum NT-proBNP and dobutamine doses
| Time | Dobutamin doses | Post-operative condition | p-values | |
|---|---|---|---|---|
| Without AHF | AHF | |||
| POD 1 | Low doses (< 5 μg) | 496.1 ± 609.9 | 2885 | 0.1f |
| Normal doses (5-15 μg) | 1.077.5 ± 2.154.5 | 2.499.8 ± 1.646.7 | 0.000f | |
| p-values | 0.041f | 0.59f | ||
| POD 2 | Low doses (< 5 μg) | 1.956.8 ± 1.728.9 | 6.088 ± 4.774.8 | 0.023f |
| Normal doses (5-15 μg) | 3.465.2 ± 3.224.7 | 9.387.5 ± 8.623.8 | 0.036f | |
| p-values | 0.049f | 0.796f | ||
| POD 3 | Low doses (< 5 μg) | 3.653.3 ± 4.984.2 | ||
| Normal doses (5-15 μg) | 5.797.8 ± 3.937 | 8.123.7 ± 4.636.0 | 0.393f | |
| p-values | 0.001f | |||
Note: POD: Post-operative day; AHF: Acute heart failure.; f. Mann-Withney U test.
Table 6.
Level of serum NT-proBNP and noradrenalin doses
| Time | Noradrenalin dosage | Post-operative condition | p-values | |
|---|---|---|---|---|
| Without AHF | AHF | |||
| POD 1 | Low dosage (<0.01 μg) | 862.7 ± 1.855.5 | 2.447.2 ± 628.5 | 0.0001f |
| Normal dosage (≥0.01 μg) | 749.8 ± 871.9 | 2.578.7 ± 2.172.9 | 0.062f | |
| p-values | 0.7f | 0.81f | ||
| POD 2 | Low dosage (<0.01 μg) | 2.335.5 ± 2.436.2 | 9.252.8 ± 9.681.3 | 0.014f |
| Normal dosage (≥0.01 μg) | 3.509 ± 2751.1 | 7.081.3 ± 4.235.8 | 0.073f | |
| p-values | 0.03f | 0.807f | ||
| POD 3 | Low dosage (<0.01 μg) | 3.952.7 ± 5.067.4 | 13.415 | 0.13f |
| Normal dosage (≥0.01 μg) | 5.804.9 ± 3.476.9 | 5.478 ± 994.2 | 0.89f | |
| p-values | 0.003f | 0.221f | ||
Note: POD: Post-operative day; AHF: Acute heart failure.; f. Mann-Withney U test.
Table 7.
Level of serum NT-proBNP and adrenalin doses
| Time | Adrenalin | Post-operative condition | p-values | |
|---|---|---|---|---|
| Without AHF | AHF | |||
| POD 1 | Low dosage (<0.05 μg) | 585.3 ± 726.6 | 2.595 | 0.12f |
| Normal doage (≥0.05) | 1.444.4 ± 2.911 | 2.523.9 ± 1.650.3 | 0.004f | |
| p-values | 0.051f | 1f | ||
| POD 2 | Low dosage (<0.05 μg) | 1.855.6 ± 1.725.2 | 2.733.8 ± 8.32.3 | 0.07f |
| Normal doage (≥0.05) | 4.047.4 ± 3.237.4 | 12.730.8 ± 7.332.3 | 0.004f | |
| p-values | 0.000f | 0.014f | ||
| POD 3 | Low dosage (<0.05 μg) | 3.140.1 ± 3.890.3 | 9.095 ± 6.109.4 | 0.045f |
| Normal doage (≥0.05) | 8.015.2 ± 5.590.9 | 6.181 | 0.694 | |
| p-values | 0.000f | 1f | ||
Note: POD: Post-operative day; AHF: Acute heart failure.; f. Mann-Withney U test.
When analyzed by the normal doses of adrenaline, in AHF group it was statistically significant compared to the without AHF group at POD 1 and POD 2.
It is statistically significant in POD 2 and POD 3 when analyzed by the low doses of adrenaline (Table 7).
Discussion
NT-proBNP reflected the grade of heart failure [19] and proved to be useful indicator for evaluating heart failure [16] In cardiac surgery, it pointed out as independent indicator to predict postoperative outcomes [20]. Compared with other indicators, it seems to be equal to euroSCORE but superior than ejection fraction [21]. It was used in various types of cardiac surgery such as percutaneous coronary intervention [22], surgery for aortic stenosis.[23], and CABG [11]. As the role of prognosis in CABG patients, NT-proBNP in combined with EuroSCORE II provided better prognosis accuracy with AUC = 0.93 and the cut-off point of NT-proBNP level was 1028 pg/ml [12]. When using it alone as an independent indicator to predict postoperative mortality, NT-proBNP also showed as valuable factor with HR = 2.02 and the cut-off point was 2,000 pg/ml [24]. To maximize the accuracy of NT-proBNP level, the cofounders that affected it must be eliminated. In general, factor affecting systolic function such as valve disease that can be elevated NT-proBNP level through elevating filling pressure of left ventricle [6]. Patients with heart valve abnormality (aortic or mitral stenosis) often had higher pre-operative levels than coronary diseases [25]. In our study, there was no patient with concomitant valve disease that reduced the risk of bias. The other important element affecting NT-ProBNP level was renal function. The relation between them was associated inversely [26] with increasing NT-proBNP level as decreasing eGFR [27]. Thus, in our study we excluded patients with renal function insufficiency to reduce the bias of NT-proBNP level.
NT-proBNP had shown evidence as a predictor of prognosis but what collecting time was better to predict also remained unknown [28]. One of the most advantages in our study was serial measurements of the NT-ProBNP that help to optimize the cut off value for specific circumstances. Using single NT-proBNP level measured before surgery to predict both severe circulatory failure and mortality in hospital after surgery [11]. Although preoperative measurement was independently predictive of postoperative outcome [29], [30], clinical assessment combined with biomarker tests also showed more useful value [7], [31]. However, natriuretic peptides were not included in post-operation follow-up. To further understanding, evaluating NT-proBNP in this period was needed. It was more valuable in prediction of mortality when using serial measurements within 12 hours [32]. It showed as strong predictors for both short-term and long-term prognosis [33].
When acute heart failure develops, NT-proBNP also increases and vice versa. That is why we used serum NT-proBNP level as an indicator of follow-up treatment in this study. It had been proved superior to standard care in guiding heart failure treatment with cost-effective, improving quality of life, and reversing ventricular remodeling [34]. Single NT-proBNP measurements can provide a diagnostic index, but it is unreasonable for treatment because of disease changing rapidly and need to use medical therapy to stabilize individual patients directly. Serial NT-proBNP measurements may provide intraindividual variation of NT-proBNP that reflects the real condition of patients. In our study, we used day by day measurements to follow continuously.The exact interpretation will lead to set up suitable treatment strategies. It can predict predicts adverse events during follow-up [35] and from that individually optimizing medical therapy for each patient [18]. In our study, level of NT-proBNP in AHF group was statistically significant compared to the without AHF group almost at POD 1 and POD 2 when analyzed by the doses of dobutamine, noradrenaline, and adrenaline (both low doses and normal doses). The dose of inotrope drugs was in line with NT-proBNP level. These results provide a valuable indicator in intensive management after CABG.
In conclusion, serial measurement of NT-proBNP level provides useful prognostic and follow-up treatment information in acute heart failure after CABG surgery.
Ethical approval
This study is approved by the ethics committee of 108 Military Central Hospital.
Informed consent
The consent and commitment were signed by the patients in the study
Footnotes
Funding: This research did not receive any financial support
Competing Interests: The authors have declared that no competing interests exist
References
- 1.O'Connor GT, et al. Results of a regional study of modes of death associated with coronary artery bypass grafting Northern New England Cardiovascular Disease Study Group. Ann Thorac Surg. 1998;66(4):1323–8. doi: 10.1016/s0003-4975(98)00762-0. [DOI] [PubMed] [Google Scholar]
- 2.Roques F, et al. Risk factors and outcome in European cardiac surgery:analysis of the EuroSCORE multinational database of 19030 patients. Eur J Cardiothorac Surg. 1999;15(6):816–22. doi: 10.1016/s1010-7940(99)00106-2. discussion 822-3. https://doi.org/10.1016/S1010-7940(99)00106-2. [DOI] [PubMed] [Google Scholar]
- 3.Parsonnet V, Dean D, Bernstein AD. A method of uniform stratification of risk for evaluating the results of surgery in acquired adult heart disease. Circulation. 1989;79(6 Pt 2):I3–12. [PubMed] [Google Scholar]
- 4.Wynne-Jones K, et al. Limitations of the Parsonnet score for measuring risk stratified mortality in the north west of England The North West Regional Cardiac Surgery Audit Steering Group. Heart. 2000;84(1):71–8. doi: 10.1136/heart.84.1.71. https://doi.org/10.1136/heart.84.1.71 PMid:10↱95 PMCid:PMC1729412. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5.Bhatti F, et al. The logistic EuroSCORE in cardiac surgery:how well does it predict operative risk? Heart. 2006;92(12):1817–20. doi: 10.1136/hrt.2005.083204. https://doi.org/10.1136/hrt.2005.083204 PMid:16547206 PMCid:PMC1↥12. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 6.Weber M, Hamm C. Role of B-type natriuretic peptide (BNP) and NT-proBNP in clinical routine. Heart. 2006;92(6):843–849. doi: 10.1136/hrt.2005.071233. https://doi.org/10.1136/hrt.2005.071233 PMid:16698841 PMCid:PMC1↞79. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 7.Cuthbertson BH, et al. N-terminal pro-B-type natriuretic peptide levels and early outcome after cardiac surgery:a prospective cohort study. Br J Anaesth. 2009;103(5):647–53. doi: 10.1093/bja/aep234. https://doi.org/10.1093/bja/aep234 PMid:19713279. [DOI] [PubMed] [Google Scholar]
- 8.Cuthbertson BH, et al. N-terminal pro-B-type natriuretic peptide concentrations and long-term outcome after cardiac surgery:a prospective cohort study. Br J Anaesth. 2013;110(2):214–21. doi: 10.1093/bja/aes379. https://doi.org/10.1093/bja/aes379 PMid:23183321. [DOI] [PubMed] [Google Scholar]
- 9.McKelvie RS, et al. The 2012 Canadian Cardiovascular Society heart failure management guidelines update:focus on acute and chronic heart failure. Canadian Journal of Cardiology. 2013;29(2):168–181. doi: 10.1016/j.cjca.2012.10.007. https://doi.org/10.1016/j.cjca.2012.10.007 PMid:23201056. [DOI] [PubMed] [Google Scholar]
- 10.Members ATF, et al. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012:The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology Developed in collaboration with the Heart Failure Association (HFA) of the ESC. European journal of heart failure. 2012;14(8):803–869. doi: 10.1093/eurjhf/hfs105. [DOI] [PubMed] [Google Scholar]
- 11.Holm J, et al. Preoperative NT-proBNP independently predicts outcome in patients with acute coronary syndrome undergoing CABG. Scand Cardiovasc J Suppl. 2013;47(1):28–35. doi: 10.3109/14017431.2012.731518. https://doi.org/10.3109/14017431.2012.731518 PMid:22989031. [DOI] [PubMed] [Google Scholar]
- 12.Holm J, et al. EuroSCORE II and N-terminal pro-B-type natriuretic peptide for risk evaluation:an observational longitudinal study in patients undergoing coronary artery bypass graft surgery. Br J Anaesth. 2014;113(1):75–82. doi: 10.1093/bja/aeu088. https://doi.org/10.1093/bja/aeu088 PMid:24727704. [DOI] [PubMed] [Google Scholar]
- 13.Polineni S, et al. Predictive Ability of Novel Cardiac Biomarkers ST2, Galectin-3, and NT-ProBNP Before Cardiac Surgery. J Am Heart Assoc. 2018;7(14) doi: 10.1161/JAHA.117.008371. https://doi.org/10.1161/JAHA.117.008371 PMid:29982227 PMCid:PMC6064859. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 14.Newton PJ, Betihavas V, Macdonald P. The role of b-type natriuretic peptide in heart failure management. Aust Crit Care. 2009;22(3):117–23. doi: 10.1016/j.aucc.2009.06.001. https://doi.org/10.1016/j.aucc.2009.06.001 PMid:19589695. [DOI] [PubMed] [Google Scholar]
- 15.Bhardwaj A, Januzzi Jr JL. Natriuretic peptide-guided management of acutely destabilized heart failure:rationale and treatment algorithm. Crit Pathw Cardiol. 2009;8(4):146–50. doi: 10.1097/HPC.0b013e3181c4a0c6. https://doi.org/10.1097/HPC.0b013e3181c4a0c6 PMid:19952548. [DOI] [PubMed] [Google Scholar]
- 16.Di Angelantonio E, et al. B-type natriuretic peptides and cardiovascular risk:systematic review and meta-analysis of 40 prospective studies. Circulation. 2009;120(22):2177–87. doi: 10.1161/CIRCULATIONAHA.109.884866. https://doi.org/10.1161/CIRCULATIONAHA.109.884866 PMid:19917883. [DOI] [PubMed] [Google Scholar]
- 17.Bettencourt P, et al. N-terminal-pro-brain natriuretic peptide predicts outcome after hospital discharge in heart failure patients. Circulation. 2004;110(15):2168–74. doi: 10.1161/01.CIR.0000144310.04433.BE. https://doi.org/10.1161/01.CIR.0000144310.04433.BE PMid:15451800. [DOI] [PubMed] [Google Scholar]
- 18.Franke J, et al. Is there an additional benefit of serial NT-proBNP measurements in patients with stable chronic heart failure receiving individually optimized therapy? Clin Res Cardiol. 2011;100(12):1059–67. doi: 10.1007/s00392-011-0340-1. https://doi.org/10.1007/s00392-011-0340-1 PMid:21779816. [DOI] [PubMed] [Google Scholar]
- 19.Clerico A, Emdin M. Diagnostic accuracy and prognostic relevance of the measurement of cardiac natriuretic peptides:a review. Clin Chem. 2004;50(1):33–50. doi: 10.1373/clinchem.2003.024760. https://doi.org/10.1373/clinchem.2003.024760 PMid:14633912. [DOI] [PubMed] [Google Scholar]
- 20.Nashef SA, et al. EuroSCORE II. Eur J Cardiothorac Surg. 2012;41(4):734–44. doi: 10.1093/ejcts/ezs043. discussion 744-5. [DOI] [PubMed] [Google Scholar]
- 21.Eliasdottir SB, et al. Brain natriuretic peptide is a good predictor for outcome in cardiac surgery. Acta Anaesthesiol Scand. 2008;52(2):182–7. doi: 10.1111/j.1399-6576.2007.01451.x. https://doi.org/10.1111/j.1399-6576.2007.01451.x PMid:17949462. [DOI] [PubMed] [Google Scholar]
- 22.Jaberg L, et al. Prognostic value of N-terminal pro-B-type natriuretic peptide in patients with acute coronary syndromes undergoing left main percutaneous coronary intervention. Circ J. 2011;75(11):2648–53. doi: 10.1253/circj.cj-11-0095. https://doi.org/10.1253/circj.CJ-11-0095 PMid:21891968. [DOI] [PubMed] [Google Scholar]
- 23.Jiang H, et al. NT-proBNP and postoperative heart failure in surgery for aortic stenosis. Open Heart. 2019;6(1):e001063. doi: 10.1136/openhrt-2019-001063. https://doi.org/10.1136/openhrt-2019-001063 PMid:31218010 PMCid:PMC6546186. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 24.Hinderliter AL, et al. Independent prognostic value of echocardiography and N-terminal pro-B-type natriuretic peptide in patients with heart failure. Am Heart J. 2008;156(6):1191–5. doi: 10.1016/j.ahj.2008.07.022. https://doi.org/10.1016/j.ahj.2008.07.022 PMid:19033018 PMCid:PMC3665504. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 25.Jiang H, et al. Impact of underlying heart disease per se on the utility of preoperative NT-proBNP in adult cardiac surgery. PloS one. 2018;13(2):e0192503. doi: 10.1371/journal.pone.0192503. https://doi.org/10.1371/journal.pone.0192503 PMid:29420603 PMCid:PMC5805306. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 26.McCullough PA, et al. B-type natriuretic peptide and renal function in the diagnosis of heart failure:an analysis from the Breathing Not Properly Multinational Study. American Journal of Kidney Diseases. 2003;41(3):571–579. doi: 10.1053/ajkd.2003.50118. https://doi.org/10.1053/ajkd.2003.50118 PMid:12612980. [DOI] [PubMed] [Google Scholar]
- 27.Chenevier-Gobeaux C, et al. Influence of renal function on N-terminal pro-brain natriuretic peptide (NT-proBNP) in patients admitted for dyspnoea in the Emergency Department:comparison with brain natriuretic peptide (BNP) Clin Chim Acta. 2005;361(1-2):167–75. doi: 10.1016/j.cccn.2005.05.021. https://doi.org/10.1016/j.cccn.2005.05.021 PMid:15993397. [DOI] [PubMed] [Google Scholar]
- 28.Balion C, et al. Testing for BNP and NT-proBNP in the diagnosis and prognosis of heart failure. Evid Rep Technol Assess (Full Rep) 2006;142:1–147. [PMC free article] [PubMed] [Google Scholar]
- 29.Fellahi JL, et al. Does preoperative B-type natriuretic peptide better predict adverse outcome and prolonged length of stay than the standard European System for Cardiac Operative Risk Evaluation after cardiac surgery? J Cardiothorac Vasc Anesth. 2011;25(2):256–62. doi: 10.1053/j.jvca.2010.05.009. https://doi.org/10.1053/j.jvca.2010.05.009 PMid:20674395. [DOI] [PubMed] [Google Scholar]
- 30.Pedrazzini GB, et al. Comparison of brain natriuretic peptide plasma levels versus logistic EuroSCORE in predicting in-hospital and late postoperative mortality in patients undergoing aortic valve replacement for symptomatic aortic stenosis. Am J Cardiol. 2008;102(6):749–54. doi: 10.1016/j.amjcard.2008.04.055. https://doi.org/10.1016/j.amjcard.2008.04.055 PMid:1≆001. [DOI] [PubMed] [Google Scholar]
- 31.De Maria R, et al. Predictive value of EuroSCORE on long term outcome in cardiac surgery patients:a single institution study. Heart. 2005;91(6):779–784. doi: 10.1136/hrt.2004.037135. https://doi.org/10.1136/hrt.2004.037135 PMid:15894777 PMCid:PMC1768917. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 32.Luers C, et al. Serial NT-proBNP measurements for risk stratification of patients with decompensated heart failure. Herz. 2010;35(7):488–95. doi: 10.1007/s00059-010-3377-4. https://doi.org/10.1007/s00059-010-3377-4 PMid:20927502. [DOI] [PubMed] [Google Scholar]
- 33.Sargento L, et al. Serial measurements of the Nt-ProBNP during the dry state in patients with systolic heart failure are predictors of the long-term prognosis. Biomarkers. 2014;19(4):302–13. doi: 10.3109/1354750X.2014.910549. https://doi.org/10.3109/1354750X.2014.910549 PMid:24735006. [DOI] [PubMed] [Google Scholar]
- 34.Januzzi JL, Troughton R. Are serial BNP measurements useful in heart failure management?Serial natriuretic peptide measurements are useful in heart failure management. Circulation. 2013;127(4):500–7. doi: 10.1161/CIRCULATIONAHA.112.120485. discussion 508. https://doi.org/10.1161/CIRCULATIONAHA.112.120485 PMid:23357662. [DOI] [PubMed] [Google Scholar]
- 35.Bayes-Genis A, et al. Serial NT-proBNP monitoring and outcomes in outpatients with decompensation of heart failure. Int J Cardiol. 2007;120(3):338–43. doi: 10.1016/j.ijcard.2006.10.009. https://doi.org/10.1016/j.ijcard.2006.10.009 PMid:17174423. [DOI] [PubMed] [Google Scholar]