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
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