Jiang Huiqi, Holm Jonas, Friberg Örjan, Vanky Farkas, Vidlund Mårten, Tajik Bashir, Yang Yanqi, Svedjeholm Rolf
Department of Cardiothoracic Surgery and Anesthesia, Faculty of Medicine and Health Sciences, Department of Health, Medicine and Caring Sciences, Linköping University, SE-581 85, Linköping, Sweden.
Department of Cardiothoracic Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-sen University of Medical Sciences, Guangzhou, Guangdong, China.
Perioper Med (Lond). 2021 Jul 13;10(1):21. doi: 10.1186/s13741-021-00194-4.
Postoperative heart failure (PHF) is the main cause for mortality after cardiac surgery but unbiased evaluation of PHF is difficult. We investigated the utility of postoperative NT-proBNP as an objective marker of PHF after coronary artery bypass surgery (CABG).
Prospective study on 382 patients undergoing isolated CABG for acute coronary syndrome. NT-proBNP was measured preoperatively, the first (POD1) and third postoperative morning (POD3). A blinded Endpoints Committee used prespecified criteria for PHF. Use of circulatory support was scrutinized.
After adjusting for confounders PHF was associated with 1.46 times higher NT-proBNP on POD1 (p = 0.002), 1.54 times higher on POD3 (p < 0.0001). In severe PHF, NT-proBNP was 2.18 times higher on POD1 (p = 0.001) and 1.81 times higher on POD3 (p = 0.019). Postoperative change of NT-proBNP was independently associated with PHF (OR 5.12, 95% CI 1.86-14.10, p = 0.002). The use of inotropes and ICU resources increased with incremental quartiles of postoperative NT-proBNP.
Postoperative NT-proBNP can serve as an objective marker of the severity of postoperative myocardial dysfunction. Due to overlap in individuals, NT-proBNP is useful mainly for comparisons at cohort level. As such, it provides a tool for study purposes when an unbiased assessment of prevention or treatment of PHF is desirable.
ClinicalTrials.gov Identifier: NCT00489827 https://clinicaltrials.gov/ct2/show/NCT00489827?term=glutamics&draw=2&rank=1 .
术后心力衰竭（PHF）是心脏手术后死亡的主要原因，但对PHF进行无偏倚评估较为困难。我们研究了术后N末端B型利钠肽原（NT-proBNP）作为冠状动脉旁路移植术（CABG）后PHF客观标志物的效用。
对382例因急性冠状动脉综合征接受单纯CABG的患者进行前瞻性研究。术前、术后第一天早晨（POD1）和术后第三天早晨（POD3）测量NT-proBNP。一个盲法终点委员会使用预先指定的PHF标准。仔细审查循环支持的使用情况。
在对混杂因素进行校正后，PHF与POD1时NT-proBNP升高1.46倍相关（p = 0.002），与POD3时升高1.54倍相关（p < 0.0001）。在严重PHF中，POD1时NT-proBNP升高2.18倍（p = 0.001），POD3时升高1.81倍（p = 0.019）。术后NT-proBNP的变化与PHF独立相关（比值比5.12，95%置信区间1.86 - 14.10，p = 0.002）。随着术后NT-proBNP四分位数的增加，血管活性药物的使用和重症监护病房资源的使用也增加。
术后NT-proBNP可作为术后心肌功能障碍严重程度的客观标志物。由于个体之间存在重叠，NT-proBNP主要用于队列水平的比较。因此，当需要对PHF的预防或治疗进行无偏倚评估时，它为研究目的提供了一种工具。
ClinicalTrials.gov标识符：NCT00489827 https://clinicaltrials.gov/ct2/show/NCT00489827?term=glutamics&draw=2&rank=1 。
