Changes in B-type Natriuretic Peptide Levels before and after Elective Major Non-cardiac Surgery in Patients With Heart Disease

Jun XIAO; Fa-kuan TANG; Bo YANG; Chang-yong GUAN; Hong-Ye WANG; Jing-Bo WANG

摘要：Objectives To measure circulating B-type natriuretic peptide (BNP) levels in patients with heart disease undergoing elective major non-cardiac surgery and to explore the relationship between the changes in BNP level and cardiac events after surgical intervention. Methods Subjects comprised 232 patients with heart disease undergoing elective major noncardiac surgery. Patients were classified into two groups based on BNP concentrations before surgery: those with BNP plasma levels ≤100 pg/mL ( Group A, n=170);and those with BNP plasma levels＞100 pg/mL (Group B, n=62).Preoperative BNP sampling was undertaken 24h before surgery, and postoperative 2 h after surgery. Screening for cardiac events was performed using clinical criteria, cardiac tropninⅠanalysis and serial electrocardiography. Results There was no significant difference in BNP concentrations between before surgery (73.5±20.6) pg/mL and after noncardiac surgery (69.3±27.5) pg/mL in group A (P＞0.05), while there was a significant difference in BNP concentrations between before surgery (149.3±73.5) pg/mL and after non-cardiac surgery (341.5±162.4) pg/mL ingroup B (P＜0.001). Patients with postoperative cardiac events had significantly higher BNP levels (207.3±99.1)pg/mL before and (416.9±202.8) pg/mL after non-cardiac surgery than those in patients with no cardiac events in group B. There was a significant difference in cardiac events between group A, in which no patient had cardiac events,and group B, in which 15 patients had cardiac events (P＜0.001). Conclusions The changes in BNP levels after noncardiac surgery were influenced by the preoperative levels of BNP, and relative to cardiac events.