Journal of Cardiothoracic and Vascular Anesthesia
Volume 26, Issue 1 , Page e6, February 2012

Reasons Elevated B-Type Natriuretic Peptide Levels Are Associated With Adverse Outcome in Patients Undergoing Cardiac Surgery

  • Yongxin Liang, MD

      Affiliations

    • Department of Anesthesiology, The Affiliated Hospital of Qingdao, University Medical College, Qingdao, China
    • Department of Anesthesiology, Nan Fang Hospital, South Medical University, Guangzhou, China
    • ,
  • Miaoning Gu, PhD

      Affiliations

    • Department of Anesthesiology, Nan Fang Hospital, South Medical University, Guangzhou, China
    • ,
  • Shiduan Wang

      Affiliations

    • Department of Anesthesiology, The Affiliated Hospital of Qingdao, University Medical College, Qingdao, China

published online 17 October 2011.

Article Outline

 

To the Editor:

We read with interest the recent article by Nozohoor et al1 who studied a total of 407 consecutive patients undergoing cardiac surgery and found that elevated B-type natriuretic peptide (BNP) levels were associated with adverse postoperative outcome (prolonged ventilation and inotropic support) and were predictive of impaired late survival. However, they did not point out why elevated BNP was associated with adverse outcome in patients undergoing cardiac surgery.

BNP levels are affected mainly by two factors. First, BNP is synthesized and secreted from cardiomyocytes in response to atrial or ventricular wall stretch.2 The main entities that elevate ventricular or atrial wall stretch after cardiac surgery are acute heart failure (HF) and atrial fibrillation (AF). BNP levels are markers of increased ventricular strain, typically from pressure or volume overload, which identify patients at risk of left ventricular impairment and increased mortality after cardiac surgery.3, 4 In addition, BNP levels rise in the setting of AF, including isolated AF.5 Thus, high BNP levels can predict the risk of HF or AF. Second, both BNP and N-terminal pro-BNP levels increase with age,6, 7 and there is a reduction in the natriuretic peptide clearance with aging.8 These three factors (ie, aging, HF, and AF) that elevate BNP levels are associated with adverse outcome in patients undergoing cardiac surgery; thus, they are an indicator of poor myocardial recovery or impaired late survival.

Back to Article Outline

References 

  1. Nozohoor S , Nilsson J , Algotsson L , et al.  Postoperative increase in B-type natriuretic peptide levels predicts adverse outcome after cardiac surgery . J Cardiothorac Vasc Anesth . 2011;25:469–475
  2. Levin ER , Gardner DG , Samson WK . Natriuretic peptides . N Engl J Med . 1998;339:321–328
  3. Francis GS , Benedict C , Johnstone DE , et al.  Comparison of neuroendocrine activation in patients with left ventricular dysfunction with and without congestive heart failure: A substudy of the studies of left ventricular dysfunction (SOLVD) . Circulation . 1990;82:1724–1729
  4. Yamamoto K , Burnett JC , Jougasaki M , et al.  Superiority of brain natriuretic peptide as a hormonal marker of ventricular systolic and diastolic dysfunction and ventricular hypertrophy . Hypertension . 1996;28:988–994
  5. Ellinor PT , Low AF , Patton KK , et al.  Discordant atrial natriuretic peptide and brain natriuretic peptide levels in lone atrial fibrillation . J Am Coll Cardiol . 2005;45:82–86
  6. Wang TJ , Larson MG , Levy D , et al.  Impact of age and sex on plasma natriuretic peptide levels in healthy adults . Am J Cardiol . 2002;90:254–258
  7. Costello-Boerrigter LC , Boerrigter G , Redfield MM , et al.  Amino-terminal pro-B-type natriuretic peptide and B-type natriuretic peptide in the general community: Determinants and detection of left ventricular dysfunction . J Am Coll Cardiol . 2006;47:345–353
  8. Kawai K , Hata K , Tanaka K , et al.  Attenuation of biologic compensatory action of cardiac natriuretic peptide system with aging . Am J Cardiol . 2004;93:719–723

PII: S1053-0770(11)00559-3

doi:10.1053/j.jvca.2011.08.003

Refers to article:

  • Postoperative Increase in B-Type Natriuretic Peptide Levels Predicts Adverse Outcome After Cardiac Surgery , 09 September 2010

    Shahab Nozohoor, Johan Nilsson, Lars Algotsson, Johan Sjögren
    Journal of Cardiothoracic and Vascular Anesthesia June 2011 (Vol. 25, Issue 3, Pages 469-475)

Journal of Cardiothoracic and Vascular Anesthesia
Volume 26, Issue 1 , Page e6, February 2012

Article Tools