Evaluation of cardiac involvement following major orthopedic surgery

Background: Cardiovascular morbidity is frequent after non-cardiac surgery and the early recognition of cardiac involvement is an essential tool for clinical risk stratification and management. The aim of this study was to investigate the behavior of traditional and emerging cardiac markers, including NT-prohormone-brain natriuretic peptide (NT-proBNP) and ischemia-modified albumin (IMA), in the perioperative period in patients undergoing major uncomplicated orthopedic surgery. Methods: A total of 37 patients undergoing major orthopedic surgery were longitudinally evaluated for NT-proBNP, IMA, cardiac troponin T (cTnT), creatine kinase isoenzyme MB and myoglobin 3 h before surgery and 4 and 72 h thereafter. Results: NT-proBNP values were significantly increased at 72 h postoperative compared to both 3 h preoperative and 4 h postoperative (NT-proBNP: 20 vs. 4.5 pmol/L, p < 0.001 and 20 vs. 5.9 pmol/L, p < 0.001). IMA levels were significantly increased at 4 and 72 h postoperative vs. 3 h preoperative (132 vs. 113 kU/L, p=0.02 and 151 vs. 113 kU/L, p < 0.001). In a stepwise regression model, the perioperative liquid amount and degree of modification in postoperative creatinine levels (delta-creatinine) were independently related to the NT-proBNP increase. Conclusions: The significant increase observed in NTproBNP suggests that patients undergoing major uncomplicated orthopedic surgery may develop subclinical cardiac stress, presumably attributable to the considerable infusion of liquids. The clinical significance of this finding deserves further investigation, especially in patients at higher risk of heart failure.