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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.
  1. McMurray JJ, Adamopoulos S, Anker SD et al. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC. Eur Heart J. 2012;33 (14):1787–1847.
  2. Национальные рекомендации ВНОК и ОССН по диагностике и лечению ХСН (третий пересмотр). Журнал Сердечная Недостаточность. 2010;11 (1):3–62.
  3. European Association for Percutaneous Cardiovascular Interventions. Guidelines on myocardial revascularization: The Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2010;31 (20):2501–2555.
  4. Marui A, Kimura T, Tanaka S et al. Significance of off-pump coronary artery bypass grafting compared with percutaneous coronary intervention: a propensity score analysis. Eur J Cardiothorac Surg. 2012;41 (1):94–101.
  5. Yi G, Youn YN, Hong S et al. Midterm outcome of off-pump bypass procedures versus drug-eluting stent for unprotected left main co­ronary artery disease. Ann Thorac Surg. 2012;94 (1):15–22.
  6. Nair S, Iqbal K, Phadke M et al. Effect of cardiopulmonary bypass on tissue injury markers and endothelial activation during coronary artery bypass graft surgery. J Postgrad Med. 2012;58 (1):8–13.
  7. Chen YB, Shu J, Yang WT et al. Meta-analysis of randomized trials comparing the effectiveness of on-pump and off-pump coronary artery bypass. Chin Med J (Engl). 2012;125 (2):338–344.
  8. Nigwekar SU, Kandula P, Hix JK, Thakar CV. Off-pump coronary artery bypass surgery and acute kidney injury: a meta-ana­lysis of randomized and observational studies. Am J Kidney Dis. 2009;54 (3):413–423.
  9. Massoudy P, Wagner S, Thielmann M et al. Coronary artery bypass surgery and acute kidney injury--impact of the off-pump technique. Nephrol Dial Transplant. 2008;23 (9):2853–2860.
  10. Jarral OA, Saso S, Athanasiou T. Does off-pump coronary artery bypass surgery have a beneficial effect on mortality in patients with left ventricular dysfunction? Interact Cardiovasc Thorac Surg. 2012;14 (6):856–864.
  11. Youn YN, Shim CY, Yang H et al. Effect of diastolic dysfunction on early outcomes during elective off-pump coronary artery bypass grafting: a prospective observational study. Ann Thorac Surg. 2011;92 (2):587–593.
  12. Eren Z, Ozveren O, Buyukoner E et al. A Single-centre study of acute cardiorenal syndrome: incidence, risk factors and consequences. Cardiorenal Med. 2012;2 (3):168–176.
  13. Малов А. А. Прогноз летальных исходов при диализ-зависимом остром почечном повреждении после кардиохирургических вмешательств. Автореферат диссертации на соискание ученой степени кандидата медицинских наук. – Новосибирск, 2012. –27с.
  14. Huo W, Zhang K, Nie Z et al. Kidney injury molecule-1 (KIM‑1): a novel kidney-specific injury molecule playing potential double-edged functions in kidney injury. Transplant Rev (Orlando). 2010;24 (3):143–146.
  15. Hong S, Youn YN, Yoo KJ. Metabolic syndrome as a risk factor for postoperative kidney injury after off-pump coronary artery bypass surgery. Circulation. 2010;74 (6):1121–1126.
  16. Смирнов А. В, Каюков И. Г, Добронравов В. А. и др. Острое повреждение почек – новое понятие в нефрологии. Клиническая нефрология. 2009; 1:11–15.
  17. Lee EH, Baek SH, Chin JH et al. Preoperative hypoalbuminemia is a major risk factor for acute kidney injury following off-pump coronary artery bypass surgery. Intensive Care Med. 2012;38 (9):1478–1486.
  18. McDonagh TA, Holmer S, Raymond I et al. NT-proBNP and the diagnosis of heart failure: a pooled analysis of three European epidemiological studies. Eur J Heart Fail. 2004;6 (3):269–273.
  19. Ho JE, Liu C, Lyass A et al. Galectin-3, a marker of cardiac fibrosis, predicts incident heart failure in the community. J Am Coll Cardiol. 2012;60 (14):1249–1256.
  20. Okuyama M, Yamaguchi S, Nozaki N et al. Serum levels of soluble form of Fas molecule in patients with congestive heart failure. Am J Cardiol. 1997;79 (12):1698–1701.
  21. Lim H, Zhu YZ. Role of transforming growth factor-beta in the progression of heart failure. Cellular and Molecular Life Sciences. 2006;63 (22):2584–2596.
  22. Scheven L, Jong PE, Hillege HL et al. High-sensitive troponin T and N-terminal pro-B type natriuretic peptide are associated with cardiovascular events despite the cross-sectional association with albuminuria and glomerular filtration rate. Eur Heart J. 2012;33 (18):2272–2281.
  23. Gopal DM, Kommineni M, Ayalon N et al. Relationship of plasma Galectin-3 to renal function in patients with heart failure: effects of clinical status, pathophysiology of heart failure, and presence or absence of heart failure. J Am Heart Assoc. 2012;1 (5):e000760.
  24. Mahar MA, Rainio A, Ilves M et al. Changes in natriuretic peptides, apelin and adrenomedullin after off-pump and on-pump coronary artery bypass surgery. J Cardiovasc Surg (Torino). 2008;49 (6):783–791.
  25. Бокерия Л. А, Бокерия О. Л, Аверина И. И. и др. Оценка ремоделирования левого желудочка. – М.: НЦССХ им. А. Н. Бакулева РАМН, 2009. –36 с.
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

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