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Differential Release Kinetics of Cardiac Biomarkers in Patients Undergoing Valve Replacement Surgery
Author(s) -
Singh Satyajit,
Kapoor Aditya,
Agarwal Surendra K.,
Pande Shantanu,
Sinha Archana,
Rai Himanshu
Publication year - 2014
Publication title -
journal of cardiac surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.428
H-Index - 58
eISSN - 1540-8191
pISSN - 0886-0440
DOI - 10.1111/jocs.12280
Subject(s) - medicine , inotrope , ejection fraction , cardiology , brain natriuretic peptide , confidence interval , troponin i , mechanical ventilation , cardiogenic shock , anesthesia , heart failure , myocardial infarction
Background Differential release kinetics of cardiac biomarkers including brain natriuretic peptide (BNP), Troponin‐I, and CK‐MB following valve replacement (VR) are not well characterized. Methods and Results We serially measured these biomarkers 24 hours prior, six hours, 24 hours, 48 hours, and one month following mitral/aortic VR in 100 patients. Baseline BNP, Tn‐I, and CK‐MB levels were 304.01 pg/mL, 0.03 ng/mL, and 0.99 ng/mL, respectively. While BNP levels decreased at six hours, and then peaked at 24 hours , Tn‐I and CK‐MB levels increased within six hours and then showed declining trends by 24 hours. While Tn‐I and CK‐MB levels normalized at one month, 33% patients still had BNP > 200 pg/mL. Those with baseline BNP > 200 pg/mL more commonly had AF, higher RV systolic pressure, longer inotrope and ventilator duration, and longer mean ICU/hospital stay as compared to those with lower BNP, although echocardiographic left ventricular ejection fraction and Tn‐I/CK‐MB levels were similar . Inotrope duration >42 hours, ventilation time >29 hours, and ICU stay >4 days was seen in 42% versus 19%, 30% versus 9%, and 33% versus 14%, respectively, in those with BNP >/< 200 pg/mL. Baseline BNP had a significant positive correlation with mean inotrope duration, ICU, and hospital stay. Baseline BNP was also a significant predictor of inotrope duration (odds ratio [OR] = 5.9, 95% confidence interval [CI] = 1.20–29.68, p = 0.01) and ventilation time (OR = 4.7, 95% CI = 1.76–17.21, p = 0.02). Conclusion Release kinetics of cardiac biomarkers is significantly different following VR; BNP levels increase following an initial transient decline. Only BNP was a predictor of postoperative variables. doi: 10.1111/jocs.12280 (J Card Surg 2014;29:134–140)