Relationship between N-terminal pro-B-type natriuretic peptide (Nt-proBNP) and cardiac cycle efficiency in cardiac surgery

• Published in: Biomedicine & pharmacotherapy 2010-10, Vol.64 (8), p.511-515
• Main Authors: Scolletta, S, Ranaldi, G, Carlucci, F, Franchi, F, Romano, S.M, Biagioli, B
• Format: Article
• Language: English
• Subjects: Aged; Algorithms; Aortic Valve - surgery; Aortic Valve Stenosis - blood; Aortic Valve Stenosis - physiopathology; Aortic Valve Stenosis - surgery; Biological and medical sciences; Cardiac cycle efficiency; Cardiac Surgical Procedures; Echocardiography; Female; Hemodynamics - physiology; Humans; Internal Medicine; Left ventricular wall stress; Male; Medical Education; Medical sciences; Monitoring, Physiologic - methods; Natriuretic Peptide, Brain - blood; Nt-proBNP; Peptide Fragments - blood; Pharmacology. Drug treatments; Time Factors; Ventricular Function, Left - physiology
• ISSN: 0753-3322; 1950-6007
• DOI: 10.1016/j.biopha.2010.01.001

Abstract N-terminal pro-B-type natriuretic peptide (Nt-proBNP) is a peptide released from myocardium in response to ventricular wall stress and dysfunction. Nt-proBNP plasma levels are elevated in a variety of cardiovascular disorders and are largely used for diagnosis and treatment of cardiac diseases. The cardiac cycle efficiency (CCE) is a haemodynamic variable that represents the left ventricle wall stress and the heart's effort to maintain an adequate blood flow to tissues. We investigated the relationship between Nt-proBNP and CCE values in patients undergoing cardiac surgery. Twenty-five patients undergoing aortic valve replacement were studied. Plasma Nt-proBNP concentrations were performed by electroluminescence immunoassay before starting surgery (t0), at the end of extracorporeal circulation (t1) and 3 hours after surgery (t2). CCE measurements were acquired at the same intervals and correlations with Nt-proBNP levels were calculated. Nt-proBNP plasma concentration was 1430 ± 341 pg/ml at t0, peaked significantly at t1 (2129 ± 561 pg/ml, p < 0.001) and moderately decreased at t2 (1924 ± 477 pg/ml, p < 0.05). A direct correlation between Nt-proBNP measured at t0 and t1 was found ( r = 0.91, p < 0.001). Overall, a negative correlation between CCE and proBNP values was found ( r = −0.89, p < 0.01). Correlations between CCE and Nt-proBNP were −0.91, −0.83 and −0.88, at t0, t1 and t2, respectively ( p < 0.01). Nt-proBNP levels reflect the severity of left ventricle dysfunction in patients undergoing cardiac surgery. CCE correlated well with serum Nt-proBNP levels and seems to be a useful variable to monitor the left ventricular stress and recovery during the various phases of surgery.