B-type natriuretic peptide to assess haemodynamic status after cardiac surgery.
BACKGROUND
B-type natriuretic peptide (BNP) is the most powerful hormonal marker of left ventricular dysfunction and could be considered as an indicator of ventricular preload. The aim of this prospective study was to compare the respective value of BNP and cardiac filling pressures to assess the response to volume load after cardiac surgery.


METHODS
Thirty-seven mechanically ventilated patients suffering from acute circulatory failure immediately after cardiac surgery, and equipped with a pulmonary-artery catheter were included. All haemodynamic measurements were taken before and after volume expansion using 500 ml of 4% modified fluid gelatin.


RESULTS
Fifteen patients were volume responders (CI increase>or=15%) and 22 were non-responders. Right atrial pressure, pulmonary-artery occlusion pressure and BNP before volume loading were not significantly different between the responders and non-responders. BNP concentration before volume infusion significantly correlated to preoperative left ventricular ejection fraction, aortic cross-clamping time, serum creatinine, mean pulmonary arterial pressure and intensive care unit duration whereas no correlation was found with pulmonary-artery occlusion pressure or cardiac index.


CONCLUSIONS
BNP level after cardiac surgery was influenced by many perioperative variables, limiting its usefulness as an indicator of cardiac preload or a predictor of volume responsiveness in this population.
Mekontso-Dessap
A
A
Medical Intensive Care Unit, Université Paris XII, Centre Hospitalier Universitaire Henri Mondor, Assistance Publique-Hôpitaux de Paris INSERM U 651, 51 avenue du Maréchal de Lattre de Tassigny, 94010 Créteil Cedex, France. armand.dessap@creteil.inserm.fr
Tual
L
L
Kirsch
M
M
D'Honneur
G
G
Loisance
D
D
Brochard
L
L
Teboul
J-L
JL
D000368:Aged; D015415:Biomarkers / Q000097:blood; D002302:Cardiac Output; D006348:Cardiac Surgical Procedures; D005260:Female; D005440:Fluid Therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D011182:Postoperative Care / Q000379:methods*; D011446:Prospective Studies; D011651:Pulmonary Artery / Q000503:physiopathology; D013318:Stroke Volume; D014655:Vascular Resistance
D015415:Biomarkers; D020097:Natriuretic Peptide, Brain