Russian Heart Failure Journal 2008year Use of the NT-proBNP marker in monitoring of perioperative heart failure in oncological patients with ischemic heart disease


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2008/

Use of the NT-proBNP marker in monitoring of perioperative heart failure in oncological patients with ischemic heart disease

Shestopalova I. M., Gerasimov S. S., Kadagidze Z. G., Shelepova V. M.

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Urgency. Monitoring of perioperative heart failure (HF) in patients with IHD is needed for timely detection of patients with early cardiac disorders, silent heart failure (SHF) and cardiovascular complications. Aim. To compare the value of NT-proBNP marker vs. conventional methods for detection of CHF in oncological surgery; to establish threshold NT-proBNP values for prediction of postoperative cardiovascular complications and their outcomes. Materials and methods. Comparative evaluation of HF detection using conventional methods (echoCG; 6-min test; clinical condition scale (CCS)) and the NT-proBNP marker was performed using results of examination prior to a surgery and at 10-14 days of the postoperative period in 45 patients who underwent a radical surgery for lung (n=22), oesophagus (n=8), stomach (n=11), and large or small intestine cancer (n=4). The evaluated group was characterized by prognostically unfavorable IHD including signs of CHF associated with a considerable probability of postoperative cardiovascular complications. Results. Severity of CHF increased in 43 (95.6 %) patients. Sensitivity of conventional methods for detection of postoperative HF signs was 13.3 % for CCS, 22,3 % for echoCG and 73.3 % for the 6-min test. Sensitivity of the NT-proBNP marker corresponded to 95.6 %, which supported a high diagnostic value of the immunoenzyme assay. Preoperative NT-proBNP levels of 152.0 ± 27.3 pg/ml, 318.2 ± 162.4 pg/ml by Elecsys proBNP (Roche) reflect prediction of uncomplicated course of the postoperative period, risk of cardiovascular complications, and high risk of complications with a high probability of fatal outcomes, respectively. Postoperative NT-proBNP marker values of 700.7 ± 396.4 pg/ml reflect severity of thoraco-abdominal surgical interventions without cardiovascular complications; values of 1953.4 ± 276.3 pg/ml reflect the onset of ACS; values of 4839.6 ± 409.7 pg/ml reflect extremely unfavorable (fatal) prognosis of developed complications.
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