Predictive value of preoperative N-terminal pro-brain natriuretic peptide for postoperative early outcomes in infants with aortic coarctation_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

MU Hongwei ,  ZHU Zhongqun

Department of Cardiothoracic Surgery, Heart Center, Shanghai Children’s Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, 200127, P.R.China;

Corresponding author：

ZHU Zhongqun, Email: zzqheart@aliyun.com

Keywords：

Aortic coarctation; N-terminal-pro-brain natriuretic peptide; biomarker

DOI：

10.7507/1007-4848.201909007

Video：

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Objective To explore the predictive value of N-terminal-pro-brain natriuretic peptide (NT-ProBNP) for postoperative early outcomes in infants with aortic coarctation (CoA).Methods A retrospective study was conducted in 344 children with CoA admitted to our hospital from September 2014 to October 2017, including 206 males (59.9%) and 138 females (40.1%), with an average age of 0.2-60.0 (7.1±10.6) months. The levels of NT-proBNP, clinical characteristics, imaging data and early follow-up results were collected and analyzed.Results Compared with the normal NT-proBNP group, there were statistical differences in age, the proportion of RACHS-1≥3, the proportion of preoperative pneumonia and dysplastic aortic arch, preoperative cardiac function, left ventricular wall thickness, left ventricular dilatation, hospital stay, ICU duration, ventilator duration, duration of vasoactive drugs use, delayed chest closure, nasal continuous positive airway pressure (nCPAP), postoperative cardiac insufficiency in the abnormal NT-proBNP group (P<0.05). According to multivariate logistic regression analysis, NT-proBNP level (>3 000 pg/mL) was an independent risk factor for prolonged ICU duration [OR=3.17, 95%CI (1.61, 6.23)], prolonged ventilator duration [OR=5.84, 95%CI (2.86, 11.95)], prolonged use of vasoactive drugs [OR=2.22, 95%CI (1.22, 4.02)], postoperative cardiac insufficiency [OR=3.10, 95%CI (1.64, 5.85)]; NT-proBNP level (> 5 000 pg/mL) was an independent risk factor for delayed chest closure [OR=3.55, 95%CI (1.48, 8.50)].Conclusion NT-proBNP level in children with CoA can be affected by many factors, including age, complexity of congenital heart disease, preoperative cardiac insufficiency, et al. The level of NT-proBNP has predictive value for postoperative early outcomes.

Citation： MU Hongwei, ZHU Zhongqun. Predictive value of preoperative N-terminal pro-brain natriuretic peptide for postoperative early outcomes in infants with aortic coarctation. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2020, 27(2): 156-163. doi: 10.7507/1007-4848.201909007 Copy

1.	Nir A, Nasser N. Clinical value of NT-ProBNP and BNP in pediatric cardiology. J Card Fail, 2005, 11(5): S76-S80.
2.	Wieshammer S, Dreyhaupt J, Basler B, et al. NT-proBNP for pulmonologists: not only a rule-out test for systolic heart failure but also a global marker of heart disease. Respiration, 2009, 77(4): 370-380.
3.	Bower JK, Lazo M, Matsushita K, et al. N-terminal pro-brain natriuretic peptide (NT-proBNP) and risk of hypertension in the atherosclerosis risk in communities (ARIC) study. Am J Hypertens, 2015, 28(10): 1262-1266.
4.	Lee SM, Kwon JE, Song SH, et al. Prenatal prediction of neonatal death in single ventricle congenital heart disease. Prenat Diagn, 2016, 36(4): 346-352.
5.	Norozi K, Buchhorn R, Kaiser C, et al. Plasma N-terminal pro-brain natriuretic peptide as a marker of right ventricular dysfunction in patients with tetralogy of Fallot after surgical repair. Chest, 2005, 128(4): 2563-2570.
6.	Plymen CM, Hughes ML, Picaut N, et al. The relationship of systemic right ventricular function to ECG parameters and NT-proBNP levels in adults with transposition of the great arteries late after Senning or Mustard surgery. Heart, 2010, 96(19): 1569-1573.
7.	Popelová J, Kotaška K, Černý S, et al. Range and distribution of NT-proBNP values in stable corrected congenital heart disease of various types. Can J Cardiol, 2012, 28(4): 471-476.
8.	Langley SM, Sunstrom RE, Reed RD, et al. The neonatal hypoplastic aortic arch: decisions and more decisions. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu, 2013, 16(1): 43-51.
9.	Jenkins KJ, Gauvreau K, Newburger JW, et al. Consensus-based method for risk adjustment for surgery for congenital heart disease. J Thorac Cardiovasc Surg, 2002, 123(1): 110-118.
10.	Albers S, Mir TS, Haddad M, et al. N-terminal pro-brain natriuretic peptide: normal ranges in the pediatric population including method comparison and interlaboratory variability. Clin Chem Lab Med, 2006, 44(1): 80-85.
11.	Kaushal S, Backer CL, Patel JN, et al. Coarctation of the aorta: midterm outcomes of resection with extended end-to-end anastomosis. Ann Thorac Surg, 2009, 88(6): 1932-1938.
12.	Pérez-Piaya M, Abarca E, Soler V, et al. Levels of N-terminal-pro-brain natriuretic peptide in congenital heart disease surgery and its value as a predictive biomarker. Interact Cardiovasc Thorac Surg, 2011, 12(3): 461-466.
13.	Koch AM, Rauh M, Zink S, et al. Decreasing ratio of plasma N-terminal pro-B-type natriuretic peptide and B-type natriuretic peptide according to age. Acta Paediatr, 2006, 95(7): 805-809.
14.	Heck PB, Müller J, Weber R, et al. Value of N-terminal pro brain natriuretic peptide levels in different types of Fontan circulation. Eur J Heart Fail, 2013, 15(6): 644-649.
15.	Schou M, Gustafsson F, Corell P, et al. The relationship between N-terminal pro-brain natriuretic peptide and risk for hospitalization and mortality is curvilinear in patients with chronic heart failure. Am Heart J, 2007, 154(1): 123-129.
16.	Windhausen F, Hirsch A, Sanders GT, et al. N-terminal pro-brain natriuretic peptide for additional risk stratification in patients with non-ST elevation acute coronary syndrome and an elevated troponin T: an invasive versus conservative treatment in unstable coronary syndromes (ICTUS) substudy. Am Heart J, 2007, 153(4): 485-492.
17.	Berghaus TM, Kutsch J, Faul C, et al. The association of N-terminal pro-brain-type natriuretic peptide with hemodynamics and functional capacity in therapy-naive precapillary pulmonary hypertension: results from a cohort study. BMC Pulm Med, 2017, 17(1): 167.

1. Nir A, Nasser N. Clinical value of NT-ProBNP and BNP in pediatric cardiology. J Card Fail, 2005, 11(5): S76-S80.
2. Wieshammer S, Dreyhaupt J, Basler B, et al. NT-proBNP for pulmonologists: not only a rule-out test for systolic heart failure but also a global marker of heart disease. Respiration, 2009, 77(4): 370-380.
3. Bower JK, Lazo M, Matsushita K, et al. N-terminal pro-brain natriuretic peptide (NT-proBNP) and risk of hypertension in the atherosclerosis risk in communities (ARIC) study. Am J Hypertens, 2015, 28(10): 1262-1266.
4. Lee SM, Kwon JE, Song SH, et al. Prenatal prediction of neonatal death in single ventricle congenital heart disease. Prenat Diagn, 2016, 36(4): 346-352.
5. Norozi K, Buchhorn R, Kaiser C, et al. Plasma N-terminal pro-brain natriuretic peptide as a marker of right ventricular dysfunction in patients with tetralogy of Fallot after surgical repair. Chest, 2005, 128(4): 2563-2570.
6. Plymen CM, Hughes ML, Picaut N, et al. The relationship of systemic right ventricular function to ECG parameters and NT-proBNP levels in adults with transposition of the great arteries late after Senning or Mustard surgery. Heart, 2010, 96(19): 1569-1573.
7. Popelová J, Kotaška K, Černý S, et al. Range and distribution of NT-proBNP values in stable corrected congenital heart disease of various types. Can J Cardiol, 2012, 28(4): 471-476.
8. Langley SM, Sunstrom RE, Reed RD, et al. The neonatal hypoplastic aortic arch: decisions and more decisions. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu, 2013, 16(1): 43-51.
9. Jenkins KJ, Gauvreau K, Newburger JW, et al. Consensus-based method for risk adjustment for surgery for congenital heart disease. J Thorac Cardiovasc Surg, 2002, 123(1): 110-118.
10. Albers S, Mir TS, Haddad M, et al. N-terminal pro-brain natriuretic peptide: normal ranges in the pediatric population including method comparison and interlaboratory variability. Clin Chem Lab Med, 2006, 44(1): 80-85.
11. Kaushal S, Backer CL, Patel JN, et al. Coarctation of the aorta: midterm outcomes of resection with extended end-to-end anastomosis. Ann Thorac Surg, 2009, 88(6): 1932-1938.
12. Pérez-Piaya M, Abarca E, Soler V, et al. Levels of N-terminal-pro-brain natriuretic peptide in congenital heart disease surgery and its value as a predictive biomarker. Interact Cardiovasc Thorac Surg, 2011, 12(3): 461-466.
13. Koch AM, Rauh M, Zink S, et al. Decreasing ratio of plasma N-terminal pro-B-type natriuretic peptide and B-type natriuretic peptide according to age. Acta Paediatr, 2006, 95(7): 805-809.
14. Heck PB, Müller J, Weber R, et al. Value of N-terminal pro brain natriuretic peptide levels in different types of Fontan circulation. Eur J Heart Fail, 2013, 15(6): 644-649.
15. Schou M, Gustafsson F, Corell P, et al. The relationship between N-terminal pro-brain natriuretic peptide and risk for hospitalization and mortality is curvilinear in patients with chronic heart failure. Am Heart J, 2007, 154(1): 123-129.
16. Windhausen F, Hirsch A, Sanders GT, et al. N-terminal pro-brain natriuretic peptide for additional risk stratification in patients with non-ST elevation acute coronary syndrome and an elevated troponin T: an invasive versus conservative treatment in unstable coronary syndromes (ICTUS) substudy. Am Heart J, 2007, 153(4): 485-492.
17. Berghaus TM, Kutsch J, Faul C, et al. The association of N-terminal pro-brain-type natriuretic peptide with hemodynamics and functional capacity in therapy-naive precapillary pulmonary hypertension: results from a cohort study. BMC Pulm Med, 2017, 17(1): 167.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Predictive value of preoperative N-terminal pro-brain natriuretic peptide for postoperative early outcomes in infants with aortic coarctation

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