title: A-type and B-type natriuretic peptides in cardiac surgical procedures.
abstract: This study was performed to determine the secretion pattern and prognostic value of A-type (ANP) and B-type (BNP) natriuretic peptide in patients undergoing cardiac surgical procedures. We measured ANP and BNP in patients undergoing coronary artery bypass grafting (CABG) with (n = 28) or without (n = 32) ventricular dysfunction and in patients undergoing mitral (n = 21) or aortic (n = 24) valve replacement, respectively. Postoperative mortality was recorded up to 730 days after operation. ANP, but not BNP, concentrations were closely associated with volume reloading of the heart after aortic cross-clamp in all patients. The secretion pattern of BNP during surgery was much less uniform. BNP, but not ANP, concentrations correlated with aortic cross-clamp time (r(2) = 0.32; P = 0.006) and postoperative troponin I concentrations (r(2) = 0.22; P = 0.0009) in bypass patients, and preoperative BNP increases were associated with a more frequent postoperative (2-yr) mortality in these patients. Markedly increased preoperative BNP concentrations in mitral (3-fold) and aortic (14-fold) valve disease patients did not further increase during cardiopulmonary surgery. The data suggest that ANP is primarily influenced by intravascular volume reloading of the heart after cross-clamp, whereas the secretion of BNP is related to other factors, such as duration of ischemia and long-term left ventricular pressure and/or excessive intravascular volume. BNP, but not ANP, was shown to be a mortality risk predictor in patients undergoing CABG.
  
  
  CONCLUSIONS
  A-type natriuretic peptide is primarily influenced by volume reloading of the heart after cross-clamp, whereas the secretion of B-type natriuretic peptide (BNP) is related to the duration of ischemia and long-term left ventricular pressure and/or volume overload. Preoperative BNP, but not postoperative BNP, concentrations predict long-term outcome after coronary artery bypass grafting.
authors.affiliation: Klinik und Poliklinik für *Anästhesiologie und Operative Intensivmedizin and †Herz-, Thorax- und Gefäβchirurgie, University of Münster, Münster, Germany; and ‡Department of Biochemistry, Southwestern Medical Center at Dallas, Dallas, Texas.
authors.forename: Elmar
authors.initials: E
authors.lastname: Berendes
authors.forename: Christoph
authors.initials: C
authors.lastname: Schmidt
authors.forename: Hugo
authors.initials: H
authors.lastname: Van Aken
authors.forename: Maike Grosse
authors.initials: MG
authors.lastname: Hartlage
authors.forename: Markus
authors.initials: M
authors.lastname: Rothenburger
authors.forename: Stefan
authors.initials: S
authors.lastname: Wirtz
authors.forename: Hans Heinrich
authors.initials: HH
authors.lastname: Scheld
authors.forename: Gerhard
authors.initials: G
authors.lastname: Brodner
authors.forename: Michael
authors.initials: M
authors.lastname: Walter
mesh_terms: D000368:Aged; D000768:Anesthesia, General; D009320:Atrial Natriuretic Factor / Q000097:blood*; D015415:Biomarkers; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000401:mortality; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000401:mortality; D003327:Coronary Disease / Q000150:complications / Q000601:surgery; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D011183:Postoperative Complications / Q000453:epidemiology / Q000401:mortality; D011379:Prognosis; D011446:Prospective Studies; D019210:Troponin I / Q000097:blood; D016277:Ventricular Function, Left
chemical_list: D015415:Biomarkers; C472955:NPPA protein, human; D019210:Troponin I; D020097:Natriuretic Peptide, Brain; D009320:Atrial Natriuretic Factor