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N-terminalni B-tip natriuretski peptid (NT-proBNP) kao marker za procenu perioperativnog rizika nakon velikih nekardiohirurški intervencija

N-Terminal pro-Brain natriurethic peptide (NT-proBNP) as marker TI for perioperative risk predication of major non-cardiac surgery

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Author
Jović, Marina
Mentor
Janković, Slobodan
Committee members
Miloradović, Vladimir
Davidović, Goran
Tasić, Nebojša
Aćimović, Ljubiša
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Abstract
Cilj: Cilj istraživanja je da istražimo vrednost N-terminalnog porimoždanog natriuretskog peptida (NT-proBNP), visokosenzitivnog troponina T (hsTnT), i Lijevog indeksa ( Revidirani indeks za srčani rizik - RCRI) za stratifikaciju pacijenata koji se podvrgavaju elektivnim nekardiološkim hirurškim operacijama (ENKH). Metodologija: Ova opservaciona klinička studija obuhvataila je 212 pacijenata starijih od 55 godina koji su operisani (ENKH) u opštoj anesteziji. Krajni cilj su bili veliki nepoželjni kardiovaskularni događaji: akutni infarkt miokarda (AIM), srčani zastoj (SZ), akutna srčana slabost (ASS) i moždani udar. Rezultati: Veliki nešoželjni kardiovaskularni događaji dogodili su se u 8 (3.8%) pacijenata. Pacijenti koji su ih imali u poređenju sa pacijentima koji ih nisu imali imali su više vrednosti oba biomarkera [NT-proBNP: 222.4 ng/L vs. 115.1 ng/L (p = 0.042); hsTnT: 11.8 ng/L vs.3.21 ng/L (p < 0.0005)], pripdali su višim klasama NYHA klasifikacije [III, II / I - 5/5...9 vs. 3/153 (p < 0.040) ] i višim Lijevim klasama rizika [ 3 i 4 / 0 i 1 - 6/32 vs. 2/180 (p < 0.0005) ], bili su u lošijem funkcionalnom stanju [(5/43 vs. 3/169 (p = 0.010)], imali su pozitivnu anamnezu za miokardni infarkt [4/13 vs. 4/199 (p < 0.001)] i bili su na terapiji nitratima [ 6/53 vs. 2/159 (p<0,004) ]. Površine ispod ROC krive su pokazale da NT-proBNP (AUROC = 0.712, p = 0.042), hsTnT (AUROC = 0.855, p = 0.001) i Lijev indeks (AUROC = 0.765, p = 0.011) mogu biti prediktori velikih nepoželjnih kardiovaskularnih događaja. Zaključak: NT-proBNP, hsTnT i Lijev indeks su dobri markeri za predikciju nepoželjnih kardiovaskularnih događaja kod pacijenata koji se upućuju na elektivnu nekardiološku hirurgiju. Kardio-biomarkeri NT-proBNP i visokosenzitivni troponin T su odlični biomarkeri klinički ispoljenog i subkliničkog kardiovaskularnog morbiditeta. Oba biomarkera nose prognostičku informaciju za nepoželjne kardiovaskularne događaje u graničnim vrednostima koje su niže od zvanično prihvaćenih za dijagnozu klinički definisanih sindroma.

Aim: We aimed to examine the value of N-terminal probrain natriuretic peptide (NT-proBNP), high-sensitive troponin T (hsTnT), and Lee Index - Revised cardiac risk index (RCRI) for risk stratification of patients undergoing elective non-cardiac surgery (ENCS). Methodology: This prospective observational clinical study involving 212 patients older than 55 who underwent ENCS in general anesthesia. End points were Major Adverse Cardiovascular Events (MACE): acute myocardial infarction (AMI), cardiac arrest, acute heart failure (AHF) and stroke. Results: Major Adverse Cardiovascular Events occurred in 8 (3.8%) patients.Patients with MACE when compared whit those without MACE had: higher values of both markers [NTproBNP: 222.4 ng/L vs. 115.1 ng/L (p = 0.042), hsTnT 11.8 ng/L vs.3.21 ng/L (p < 0.0005)], were memberships to higher NYHA classis [II, III / I - 5/59 vs. 3/153 (p < 0.0400)] and to higher Lee’s classis [3, 4 / 0, 1 - 6/32 vs. 2/180 (p < 0.0005)], were in poor functional st...ate [5/43 vs. 3/169 (p = 0.010)], had positive anamnesis for prior MI [4/13 vs. 4/199 (p < 0.001)] and took nitrates in therapy [6/53 vs. 2/159 (p < 0,004)]. ROC curves showed that NT-proBNP (AUROC = 0.712, p = 0.042), hsTnT (AUROC = 0.855, p = 0.001) and Lee index (AUROC = 0.765, p = 0.011) can be predictors of MACE. Conclusion: NT-proBNP, high-sensitive troponin T and RCRI are good markers for prediction of MACE in patients undergoing elective non-cardiac surgery. Cardio biomarkers NT-proBNP and hsTnT are excellent biomarkers for clinically manifest and subclinical cardiovascular morbidity. They carry prognostic information for adverse perioperative cardiovascular events at cutoff values lower than those officially accepted for diagnosing clinically defined syndromes.

Faculty:
Универзитет у Крагујевцу, Факултет медицинских наука
Date:
20-04-2015
Keywords:
N-terminalni promoždani natriuretski peptid / nekardiološka elektivna hirurgija
[ Google Scholar ]
Handle
https://hdl.handle.net/21.15107/rcub_nardus_3757
URI
http://eteze.kg.ac.rs/application/showtheses?thesesId=1807
https://nardus.mpn.gov.rs/handle/123456789/3757
https://fedorakg.kg.ac.rs/fedora/get/o:464/bdef:Content/download

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