Abstract 2328: Preoperative Levels of B-Type Natriuretic Peptide, and Not Inflammation, Can Predict an Adverse Outcome Among Patients with Ischemic Cardiomyopathy Undergoing Heart Surgery
Introduction. Patients with ischemic cardiomyopathy (IC) undergoing heart surgery are at high risk for postoperative events.
Aim. Determine the influence of preoperative B-type natriuretic peptide (BNP) levels and inflammation on outcome of patients with IC submitted to an elective heart surgery. We hypothesized that patients with high BNP levels and/or in a proinflammatory state would encounter increased events after surgery.
Methods. In a prospective design, 34 IC patients (79% men, 62±10 years, LVEF ≤ 0.40) undergoing heart surgery were compared to 28 control patients (CT, 82% men, 60±11 years, LVEF > 0.40). Surgery consisted of coronary artery bypass grafting (90% for IC and 100% for CT patients) and additional valvular surgery or LV aneurysmectomy (38% of IC patients). BNP and inflammation markers (IM; interleukin [IL]-6, IL-8, P-selectin, intercellular adhesion molecule [ICAM]-1 and C-reactive protein [CRP]) in the systemic circulation were determined, and postoperative events registered.
Results. See table⇓ for BNP and IM data. Before surgery, IC patients presented greater BNP and ICAM-1 levels than CT patients. After surgery, IL-6, P-sel and CRP increased in both IC and CT patients. In a multivariate logistic regression analysis, for IC patients, preoperative BNP levels > 190 pg/ml correlated markedly with intensive care unit stay > 5 days and with the need for prolonged ventilation and dobutamine use (OR 1.92 [1.68 –2.18]).
Conclusion. These data suggest that: 1-based on IL-6, P-sel and CRP changes, heart surgery induces a systemic immune-inflammation for IC and CT patients; and, 2-preoperative BNP > 190 pg/ml can predict an adverse postoperative outcome in IC patients. Preoperative BNP is a useful risk stratification tool for patients with IC undergoing heart surgery.