Plasma brain natriuretic peptide and cardiac troponin I concentrations after adult cardiac surgery:: Association with postoperative cardiac dysfunction and 1-year mortality

Objective. The purpose of the present study was to evaluate the prognostic implications of perioperative B-type natriuretic peptide (BNP) and cardiac troponin I concentrations in patients undergoing cardiopulmonary bypass for cardiac surgery. Design. Prospective observational study. Setting: Biochemistry laboratory and surgical care unit in a university hospital. Patients. A total of 92 consecutive patients undergoing elective coronary artery (43 patients) or valve surgery (49 patients). Interventions: None. Measurements and Main Results. BNP and cardiac troponin I concentrations were measured before surgery (day 0), and at day 1 after surgery. Postoperative cardiac dysfunction was defined as low cardiac output or hemodynamic instability requiring inotropic support for > 24 hrs or congestive heart failure until day 5. One-year survival was also evaluated. Univariate and multivariate analyses were performed. An important BNP secretion was systematically observed after cardiac surgery. Independent predictors of cardiac dysfunction were preoperative New York Health Association class and BNP and cardiac troponin I concentrations measured at day 1. Patients with an elevation of both markers have a 12-fold increased risk of postoperative heart failure. The use of both markers in combination predicted better postoperative heart failure than each one separately. Age, low preoperative left ventricular ejection fraction, and elevated BNP at day 1 (> 352 pg/mL) were associated with an increased mortality rate at 1 yr. In multivariate analysis, only left ventricular ejection fraction was significantly associated with 1-yr survival. Conclusions. Postoperative plasma BNP and cardiac troponin I levels are independent predictors of postoperative cardiac dysfunction after cardiac surgery. Simultaneous measurement of BNP and cardiac troponin I improve the risk assessment of postoperative cardiac dysfunction. However, the association between BNP levels and 1-yr outcome was no longer significant after adjustment on left ventricular ejection fraction.