Utility of brain natriuretic peptide as a marker of early cardiac risk in patients undergoing elective abdominal aortic aneurism repair

Introduction

Patients undergoing elective aortic abdominal aneurysm repair are at increased risk of perioperative mortality and morbidity. The majority of deaths in this setting are related to cardiac complications. Brain natriuretic peptide (BNP) has recently emerged as a predictive value in this context [1]. The current study tests this hypothesis.

Methods

We studied 34 patients. After a preoperative interview by a senior anesthetist who assessed cardiovascular status following the recommendations proposed by the American College of Cardiology-American Heart Association, BNP levels were obtained just before surgery and were blinded to the anesthetist. Myocardial injury was defined as a cardiac troponine concentration ≥ 1.5 ng/ml. Statistical analysis was performed using Student's t test.

Results

We found cardiac troponine ≥ 1.5 ng/ml in five patients with myocardial injury. The preoperative BNP value was 379 (SD ± 282) pg/ml in patients with myocardial injury and 88.7 (SD ± 61) pg/ml in those without events. The two-tailed P value was 0.08.

Conclusion

Preoperative BNP levels are higher in patients who develop myocardial injury; however, the P value was not quite significant. This could be explained with intraoperative surgical complications (technical difficulties, blood loss, acute hypotension, longer cross-clamp) affecting the outcome of the patient with low BNP.