Time-dependent changes in heart failure and renal function during the early postoperative period after off-pump coronary bypass surgery: predictive capabilities of serum markers
Yakovleva A.S., Mirolyubova O.A., Sukhanova Zh.V.
Keywords: coronary artery bypass, biomarkers, heart failure, kidneys function
DOI: 10.18087 / rhfj.2013.5.1829
Background. In IHD, the surgery of choice is coronary bypass (CB) without extracorporeal circulation (ECC). Changes in renal function and HF after this procedure are insufficiently studied; searching for early predictors of impaired renal function and HF among current biomarkers is in progress. Aim. Evaluating early changes in the course of HF with preserved EF (HF-PEF) and in the renal function after CB without ECC and significance of serum biomarkers for HF-PEF prognosis. Materials and methods. The study included 30 patients (57.9±4.7 years) with HF-PEF after CB without ECC. Time-related changes in HF and renal function were evaluated using laboratory data, including pro-brain natriuretic peptide (NT-proBNP), galectin-3 (Gal-3), transforming growth factor-1β (TGF1β), and soluble Fas-receptor (sFas), before the surgery, at 48 h and 7 days and echocardioscopy (echoCS) data before the surgery and at 7 days. Results. Baseline levels of NT-proBNP (62.0 (42.0–71.5) pg / ml) and Gal-3 (12.8 (3.5–28.9) pg / ml) confirmed the absence of severe HF in this group. After the surgery, only time-related changes in NT-proBNP and sFas were observed. Of all biomarkers, only NT-proBNP >68.0 pg / ml at 7 days post-CB without ECC could be used for prediction of III FC HF (p=0.007); sensitivity 70 %, specificity 87.5 %. In the early postoperative period, EF was increased from 57.7±7.3 to 63.2±6.3 % (p<0.001) and LV myocardial mass index (LVMMI) was decreased from 150.67±38.77 to 133.67±36.56 g / m2 (р=0.001). Baseline NT-proBNP (p=0.041) and serum creatinine (sCr) (p=0.019) levels and the GFR at 7 days post-CB to baseline GFR ratio (p=0.043) were predictors of above mentioned at 7 days after CB without ECC. Incidence of acute kidney injury (AKI) (R) was 3 (10 %) cases. BMI >28.7 kg / m2 was a predictor for GFR decrease by day 7 (33.3 % of patients) after CB without ECC; sensitivity 80 %, specificity 75 %. sCr and GFR did not change with time; however, postoperative active recovery of renal function was observed in patients with baseline GFR <60 ml / min / 1.73 m2 (13.3 %). Patients with increased levels of NTproBNP+Gal-3 at 7 days of CB without ECC had higher sCr levels (р=0.019) and lower GFR (р=0.027). Conclusion. Evaluating the combination of classic markers for HF and renal function and up-to-date markers, which show «cross» significance (NTproBNP+Gal-3), provides an efficient approach to prediction of impaired renal function and HF time course in the early period after CB without ECC.
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Yakovleva A.S., Mirolyubova O.A., Sukhanova Zh.V. Time-dependent changes in heart failure and renal function during the early postoperative period after off-pump coronary bypass surgery: predictive capabilities of serum markers. Russian Heart Failure Journal. 2013;14 (5):256-262