Combined measurements of N-terminal pro-brain natriuretic peptide and cardiac troponins in potential organ donors.
OBJECTIVE
Brain death may induce cardiac dysfunction. In potential organ donors measurements of N-terminal pro-brain natriuretic peptide (NT-proBNP) and circulating cardiac troponins T and I (cTnT and cTnI), alone or in combination, are performed to investigate the accuracy of these biomarkers for early diagnosis of left ventricular systolic dysfunction.


METHODS
Prospective study in a multidisciplinary intensive care unit of an university hospital.


METHODS
63 brain-dead patients scheduled for multiple organ harvesting.


RESULTS
We measured NT-proBNP, cTnT, and cTnI and determined fractional area change (FAC) using transesophageal echocardiography. Forty-five patients had normal FAC, 9 a moderate decrease in FAC (30-50), and 9 a severe decrease in FAC (<or=30%). NT-proBNP and cTnT concentrations were significantly higher in patients with a severe decrease in FAC than in those with a moderate decrease. Combining measurements of these two biomarkers, the sensitivity of the test to predict severe decrease in FAC increased significantly to reach 1.00 compared with the sensitivities of individual measurements. The ROC curve area of combined measurements of NT-proBNP and cTnT was significantly higher than single measurements: 0.87 vs. 0.82 for NT-proBNP, 0.78 for cTnT, and 0.72 for cTnI.


CONCLUSIONS
In potential organ donors the combined measurement of NT-proBNP and cTnT concentrations is more accurate than individual measurement of NT-proBNP, cTnT, and cTnI in the early diagnosis of severe left ventricular systolic dysfunction. These findings may lead to improve the quality of cardiac care of the potential organ donors.
Nicolas-Robin
Armelle
A
Centre Hospitalo-Universitaire Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Department of Anesthesiology and Critical Care, Université Pierre et Marie Curie-Paris 6, 75651 Paris Cédex 13, France. armelle.nicolas-robin@psl.aphp.fr
Salvi
Nadège
N
Medimagh
Sassi
S
Amour
Julien
J
Le Manach
Yannick
Y
Coriat
Pierre
P
Riou
Bruno
B
Langeron
Olivier
O
D000328:Adult; D015415:Biomarkers; D001926:Brain Death / Q000503:physiopathology; D005260:Female; D005602:France; D006801:Humans; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods; D020097:Natriuretic Peptide, Brain / Q000032:analysis* / Q000097:blood; D010446:Peptide Fragments / Q000032:analysis* / Q000097:blood; D009927:Tissue and Organ Procurement; D014336:Troponin / Q000032:analysis* / Q000097:blood; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis
D015415:Biomarkers; D010446:Peptide Fragments; D014336:Troponin; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain