Advertisement

N-Terminal Pro-Brain Natriuretic Peptide and Angiotensin-Converting Enzyme-2 Levels and Their Association With Postoperative Cardiac Complications After Emergency Orthopedic Surgery

      The prognostic usefulness of the cardiac biomarkers N-terminal pro-brain natriuretic peptide (NT-proBNP) and angiotensin-converting enzyme 2 (ACE-2), in predicting adverse cardiac outcomes after orthopedic surgery is not well studied. The aim of our study was to determine the usefulness of perioperative NT-proBNP and ACE-2 for predicting cardiac events after emergency orthopedic surgery. The perioperative NT-proBNP and ACE-2 levels were determined in 187 consecutive patients aged >60 years who underwent orthopedic surgery with 1 year of follow-up for any cardiac complications (defined as acute myocardial infarction, congestive cardiac failure, atrial fibrillation, or major arrhythmia) and death. Of the 187 patients, 20 (10.7%) sustained an in-hospital postoperative cardiac complication. The total all-cause in-hospital and 1-year mortality rate was 1.6% (3 of 187) and 8.6% (16 of 187), respectively. The median preoperative and postoperative NT-proBNP level was greater in patients who sustained an in-hospital cardiac event than in those who had not (386 vs 2,273 pg/ml, p <0.001, and 605 vs 4,316 pg/ml, p <0.001, respectively). Similarly, the postoperative median ACE-2 levels were significantly greater in the patients with an in-hospital cardiac event than in those without (25.3 vs 39.5 pmol/ml/min, p = 0.012). A preoperative NT-proBNP level of ≥741 pg/ml (odds ratio 4.5, 95% confidence interval 1.3 to 15.2, p = 0.017), postoperative troponin elevation (odds ratio 4.9, 95% confidence interval 1.3 to 18.9, p = 0.022), and number of co-morbidities (odds ratio 1.8, 95% confidence interval 1.2 to 2.8, p = 0.009) independently predicted in-hospital cardiac complications on multivariate analysis. The pre- and postoperative NT-proBNP level independently predicted 1-year cardiovascular complications but not the ACE-2 levels. In conclusion, elevated perioperative NT-proBNP predicted in-hospital and 1-year cardiac events in an emergency orthopedic population but the ACE-2 levels did not, which requires additional study for validation.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Cardiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Dernellis J.
        • Panaretou M.
        Assessment of cardiac risk before non-cardiac surgery: brain natriuretic peptide in 1590 patients.
        Heart. 2006; 92: 1645-1650
        • Yun K.H.
        • Jeong M.H.
        • Oh S.K.
        • Choi J.-H.
        • Rhee S.J.
        • Park E.M.
        • Yoo N.J.
        • Kim N.-H.
        • Ahn Y.K.
        • Jeong J.-W.
        Preoperative plasma N-terminal pro-brain natriuretic peptide concentration and perioperative cardiovascular risk in elderly patients.
        Circ J. 2008; 72: 195-199
        • Montagnana M.
        • Lippi G.
        • Regis D.
        • Fava C.
        • Viola G.
        • Bartolozzi P.
        • Guidi G.C.
        Evaluation of cardiac involvement following major orthopedic surgery.
        Clivol Chem Lab Med. 2006; 44: 1340-1346
        • Chong C.P.
        • Ryan J.E.
        • van Gaal W.J.
        • Lam Q.T.
        • Sinnappu R.N.
        • Burrell L.M.
        • Savige J.
        • Lim W.K.
        Usefulness of N-terminal pro-brain natriuretic peptide (NT-proBNP) to predict postoperative cardiac complications and Long-term mortality after emergency lower limb orthopedic surgery.
        Am J Cardiol. 2010; 106: 865-872
        • Provenchère S.
        • Berroeta C.
        • Reynaud C.
        • Baron G.
        • Poirier I.
        • Desmonts J.-M.
        • Iung B.
        • Dehoux M.
        • Philip I.
        • Bénessiano J.
        Plasma brain natriuretic peptide and cardiac troponin I concentrations after adult cardiac surgery: association with postoperative cardiac dysfunction and 1-year mortality.
        Crit Care Med. 2006; 34: 995-1000
        • Mahla E.
        • Baumann A.
        • Rehak P.
        • Watzinger N.
        • Vicenzi M.N.
        • Maier R.
        • Tiesenhausen K.
        • Metzler H.
        • Toller W.
        N-terminal pro-brain natriuretic peptide identifies patients at high risk for adverse cardiac outcome after vascular surgery.
        Anesthesiology. 2007; 106: 1088-1095
        • Yeh H.M.
        • Lau H.P.
        • Lin J.M.
        • Sun W.Z.
        • Wang M.J.
        • Lai L.P.
        Preoperative plasma N-terminal pro-brain natriuretic peptide as a marker of cardiac risk in patients undergoing elective non-cardiac surgery.
        Br J Surg. 2005; 92: 1041-1045
        • Mizrahi E.H.
        • Fleissig Y.
        • Arad M.
        • Adunsky A.
        The impact of previous strokes on the rehabilitation of elderly patients sustaining a hip fracture.
        Arch Phys Med Rehabil. 2007; 88: 1136-1139
        • Burrell L.M.
        • Johnston C.I.
        • Tikellis C.
        • Cooper M.E.
        ACE2, a new regulator of the renin-angiotensin system.
        Trends Endocrinol Metab. 2004; 15: 166-169
        • Burrell L.M.
        • Risvanis J.
        • Kubota E.
        • Dean R.G.
        • MacDonald P.S.
        • Lu S.
        • Tikellis C.
        • Grant S.L.
        • Lew R.A.
        • Smith A.I.
        • Cooper M.E.
        • Johnston C.I.
        Myocardial infarction increases ACE2 expression in rat and humans.
        Eur Heart J. 2005; 26 (322–364): 369-375
        • Lew R.A.
        • Warner F.J.
        • Hanchapola I.
        • Yarski M.A.
        • Manohar J.
        • Burrell L.M.
        • Smith A.I.
        Angiotensin-converting enzyme 2 catalytic activity in human plasma is masked by an endogenous inhibitor.
        Exp Physiol. 2008; 93: 685-693
        • Chong C.P.
        • Lam Q.T.
        • Ryan J.E.
        • Sinnappu R.N.
        • Lim W.K.
        Incidence of post-operative troponin I rises and one year mortality after emergency orthopaedic surgery in older patients.
        Age Ageing. 2009; 38: 168-174
        • Thygesen K.
        • Alpert J.S.
        • White H.D.
        • Joint ESC/ACCF/AHA/WHF Task Force for the Redefinition of Myocardial Infarction
        Universal definition of myocardial infarction.
        J Am Coll Cardiol. 2007; 50: 2173-2195
        • Cuthbertson B.H.
        • Almiri A.R.
        • Croal B.L.
        • Rajagopalan S.
        • Alozairi O.
        • Brittenden J.
        • Hillis G.S.
        Utility of B-type natriuretic peptide in predicting perioperative cardiac events in patients undergoing major non-cardiac surgery.
        Br J Anaesth. 2007; 99: 170-176
        • Berry C.
        • Kingsmore D.
        • Gibson S.
        • Hole D.
        • Morton J.J.
        • Byrne D.
        • Dargie H.J.
        Predictive value of plasma brain natriuretic peptide for cardiac outcome after vascular surgery.
        Heart. 2006; 92: 401-402
        • Feringa H.H.H.
        • Bax J.J.
        • Elhendy A.
        • de Jonge R.
        • Lindemans J.
        • Schouten O.
        • van den Meiracker A.H.
        • Boersma E.
        • Schinkel A.F.L.
        • Kertai M.D.
        • van Sambeek M.R.H.M.
        • Poldermans D.
        Association of plasma N-terminal pro-B-type natriuretic peptide with postoperative cardiac events in patients undergoing surgery for abdominal aortic aneurysm or leg bypass.
        Am J Cardiol. 2006; 98: 111-115
        • Feringa H.H.H.
        • Schouten O.
        • Dunkelgrun M.
        • Bax J.J.
        • Boersma E.
        • Elhendy A.
        • de Jonge R.
        • Karagiannis S.E.
        • Vidakovic R.
        • Poldermans D.
        Plasma N-terminal pro-B-type natriuretic peptide as long-term prognostic marker after major vascular surgery.
        Heart. 2007; 93: 226-231
        • Karthikeyan G.
        • Moncur R.A.
        • Levine O.
        • Heels-Ansdell D.
        • Chan M.T.V.
        • Alonso-Coello P.
        • Yusuf S.
        • Sessler D.
        • Villar J.C.
        • Berwanger O.
        • McQueen M.
        • Mathew A.
        • Hill S.
        • Gibson S.
        • Berry C.
        • Yeh H.-M.
        • Devereaux P.J.
        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?.
        J Am Coll Cardiol. 2009; 54: 1599-1606
        • Bolliger D.
        • Seeberger M.D.
        • Filipovic M.
        Pre-operative cardiac risk assessment in noncardiac surgery: Are natriuretic peptides the Magic bullet?.
        J Am Coll Cardiol. 2009; 54: 1607-1608
        • Rodseth R.N.
        • Padayachee L.
        • Biccard B.M.
        A meta-analysis of the utility of preoperative brain natriuretic peptide in predicting early and intermediate-term mortality and major adverse cardiac events in vascular surgical patients.
        J Anesth. 2008; 63: 1226-1233