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Release kinetics of cardiac biomarkers in patients undergoing valve replacement surgery for rheumatic heart disease
© Agarwal et al; licensee BioMed Central Ltd. 2013
Published: 11 September 2013
Levels of brain natriuretic peptide (BNP) increase following CABG and predict post-operative outcomes. Release kinetics of BNP, Troponin-I (TnI) and CKMB after valve replacement are not well characterized.
We assessed levels of these biomarkers 24 hours prior and 6,24, 48 hrs, 1 month following mitral/aortic valve replacement in 50 patients (mean age 36.7 yrs, LVEF 54.4%, 80% males).
Mean baseline BNP, TnI and CK-MB levels were 304.01 pg/ml, 0.03 ng/ml and 0.99 ng/ml. BNP initially decreased within 6 hours of surgery, and peaked at 24 hours; TnI and CKMB showed an early rise, with declining trends by 24 hrs. Peak BNP levels occurred in 90% patients by 24-48 hrs, while for TnI and CKMB this occurred in only 15-30%.Mean delta (peak-baseline) BNP, TnI, CKMB was 660.1pg/ml, 8.1ng/ml and 32.3ng/ml.At 1 month, levels of all biomarkers were not significantly different from baseline. Patients with higher baseline BNP more commonly had atrial fibrillation (71vs 33%,p=.02), higher right ventricular systolic pressure (69.7vs43.9 mm Hg,p< 0.001),higher Euroscore II(2.42vs1.49,p=0.006),longer inotrope duration (56.1vs26.5hrs,p=0.03), ventilator support time (35.6vs21.7 hrs,p=0.04), longer ICU (4.8vs3.2 days,p=0.02) and hospital stay (6.8vs5.2 days,p=0.03). Inotrope duration>42 hrs, ventilation time>29 hrs and ICU stay>4 days was seen in 42%vs19%, 30%vs9% and 33%vs14% respectively in patients with baseline BNP >/< 200 pg/ml. Only baseline BNP was a significant predictor of inotrope duration (p=0.01) and ventilation time (p=0.02). Only 24 hour post-operative BNP and delta BNP were predictors of inotrope duration>42 hrs, ventilation time>29 hrs and ICU stay>4 days.
Release kinetics of cardiac biomarkers following valve surgery are significantly different from each other. Of all the biomarkers, only BNP levels had an association with post-operative inotrope duration, ventilation time and ICU stay in patients undergoing valve replacement.
This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.