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Nt-proBNP and C-reactive protein as predictors of atrial fibrillation in coronary bypass surgery

Rubanenko O. A.
State Budgetary Educational Institution, “Samara State Medical University” of the RF Ministry of Health Care, Chapaevskaya 89, Samara 443099

Keywords: IHD, NT-proBNP, diagnostics, atrial fibrillation, CABG

DOI: 10.18087/rhj.2016.2.2164

Background. In coronary bypass (CB) surgery, postoperative atrial fibrillation (POAF) is a serious complication. Role of several factors in development of POAF has been actively studied. Aim. To evaluate the effect of NT-proBNP and С-reactive protein (CRP) on development of POAF during CB in patients with IHD. Materials and methods. A prospective evaluation of 96 patients divided into two groups: group 1, patients without POAF (67 patients; 80.6 % males; mean age 57.9±7.3), group 2, patients with POAF (29 patients; 86 % males; mean age, 64.0±8.4). Levels of NT-proBNP, CRP and fibrinogen were measured on admission and after CB, at an average of 3.8±1.4 days. Results. POAF developed in 30.2 % of cases, at an average of 4.9±3.8 days. CRP and fibrinogen levels did not significantly differ between the groups. The post-surgery level of NT-proBNP was significantly higher in patients with AF (922.2±503.1 vs. 556.9±221.8 pg/ml; р=0.033). One-factor regression analysis showed that the odds ratio (OR) for development of POAF was 2.7 (95 % CI, 1.1–7.2; р=0.003) for patients with FC III angina; 2.9 (95 % CI, 1.3–8.5; р=0.004) for patients with FC III CHF; 3.5 (95 % CI, 1.7–7.6; р<0.0001) for the left ventricle dimension exceeding 41 mm; 1.5 (95 % CI, 1.03–5.6; р=0.006) for IHD duration of more than 20 months; 2.2 (95 % CI, 1.07–5.2; р=0.04) for an age older than 62; and 4.2 (95 % CI, 1.3–9.8; р=0.006) for postoperative NT-proBNP level higher than 526.6 pg /ml. After a multifactorial analysis, the predictive value remained only for the LA dimension >41 mm with OR 2.2 (95 % CI, 1.1–8.5; р=0.0001). For the rest of the data the p value became non-significant. Conclusion. CRP concentration was not associated with development of arrhythmia. At the same time, NT-proBNP was found to be an independent predictor for AF in early postoperative period of CB. The LA dimension was the only independent factor increasing the incidence of arrhythmia following surgical myocardial revascularization.
  1. Almassi GH, Wagner TH, Carr B, Hattler B, Collins JF, Quin JA et al. Postoperative atrial fibrillation impacts on costs and one-year clinical outcomes: the Veterans Affairs Randomized On / Off Bypass Trial. Ann Thorac Surg. 2015 Jan;99 (1):109–14.
  2. Bidar E, Maesen B, Nieman F, Verheule S, Schotten U, Maessen JG. A prospective randomized controlled trial on the incidence and predictors of late phase post-operative atrial fibrillation up to 30 days and the preventive value of biatrial pacing. Heart Rhythm. 2014 Jul;11 (7):1156–62.
  3. Sinner MF, Stepas KA, Moser CB, Krijthe BP, Aspelund T, Sotoodehnia N et al. B-type natriuretic peptide and C-reactive protein in the prediction of atrial fibrillation risk: the CHARGE-AF Consortium of community-based cohort studies. Europace. 2014 Oct;16 (10):1426–33.
  4. Pilatis ND, Anyfantakis ZA, Spiliopoulos K, Degiannis D, Chaidaroglou A, Vergou G et al. The Role of BNP and CRP in Predicting the Development of Atrial Fibrillation in Patients Undergoing Isolated Coronary Artery Bypass Surgery. ISRN Cardiol. 2013 Dec 25;2013:235018.
  5. Andrade J, Khairy P, Dobrev D, Nattel S. The clinical profile and pathophysiology of atrial fibrillation relationship among clinical features, epidemiology, and mechanisms. Circ Res. 2014 Apr 25;114 (9):1453–68.
  6. Drewniak W, Snopek G, Zarukiewicz M, Borys M, Dabrowski M. Prognostic value of the N-terminal pro-B-type natriuretic peptide in the elderly with acute myocardial infarction. Kardiol Pol. 2008 Jul;66 (7):750–5.
  7. Karthikeyan G, Moncur RA, Levine O, Heels-Ansdell D, Chan MT, Alonso-Coello P et al. Is a pre-operative brain natriuretic peptide or N-terminal pro-B-type natriuretic peptide measurement an independent predictor of adverse cardiovascular outcomes within 30 days of noncardiac surgery? A systematic review and meta-ana­lysis of observational studies. J Am Coll Cardiol. 2009 Oct 20;54 (17):1599–606.
  8. Hernández-Romero D, Vílchez JA, Lahoz Á, Romero-Aniorte AI, Orenes-Piñero E, Caballero L et al. High-sensitivity troponin T as a biomarker for the development of atrial fibrillation after cardiac surgery. Eur J Cardiothorac Surg. 2014 Apr;45 (4):733–8.
  9. El-Chami MF, Kilgo PD, Elfstrom KM, Halkos M, Thourani V, Lattouf OM et al. Prediction of new onset atrial fibrillation after cardiac revascularization surgery. Am J Cardiol. 2012 Sep 1;110 (5):649–54.
  10. Parsaee M, Moradi B, Esmaeilzadeh M, Haghjoo M, Bakhshandeh H, Sari L. New onset atrial fibrillation after coronary artery bypas­ses grafting; an evaluation of mechanical left atrial function. Arch Iran Med. 2014 Jul;17 (7):501–6.
  11. Gibson PH, Croal BL, Cuthbertson BH, Rae D, McNeilly JD, Gibson G et al. Use of preoperative natriuretic peptides and echocardiographic parameters in predicting new-onset atrial fibrillation after coronary artery bypass grafting: a prospective comparative study. Am Heart J. 2009 Aug;158 (2):244–51.
  12. Kangasniemi OP, Biancari F, Luukkonen J, Vuorisalo S, Satta J, Pokela R, Juvonen T. Preoperative C-reactive protein is predictive of long-term outcome after coronary artery bypass surgery. Eur J Cardiothorac Surg. 2006 Jun;29 (6):983–5.
  13. Gasparovic H, Burcar I, Kopjar T, Vojkovic J, Gabelica R, Biocina B, Jelic I. NT-pro-BNP, but not C-reactive protein, is predictive of atrial fibrillation in patients undergoing coronary artery bypass surgery. Eur J Cardiothorac Surg. 2010 Jan;37 (1):100–5.
  14. Ucar HI, Tok M, Atalar E, Dogan OF, Oc M, Farsak B et al. Predictive significance of plasma levels of interleukin-6 and high-sensitivity C-reactive protein in atrial fibrillation after coronary artery bypass surgery. Heart Surg Forum. 2007;10 (2):E131–5.
Rubanenko O. A. Nt-proBNP and C-reactive protein as predictors of atrial fibrillation in coronary bypass surgery. Russian Heart Journal. 2016;15 (2):88–92

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