title: Predictive value of NT-proBNP in vascular surgery patients with COPD and normal left ventricular systolic function.
abstract: N-terminal pro-B-type natriuretic peptide (NT-proBNP) is commonly used to identify a cardiac cause of dyspnoea. However, patients with chronic obstructive pulmonary disease (COPD) may also have increased plasma NT-proBNP levels because of right-sided myocardial stress caused by pulmonary hypertension. We investigated the relationship between COPD and elevated NT-proBNP levels as well as the impact of elevated NT-proBNP levels on mortality in vascular surgery patients with normal left ventricular systolic function. Prior to vascular surgery, NT-proBNP levels, pulmonary function and left ventricular ejection fraction (LVEF) were assessed in 376 patients. Only patients with a LVEF > 40% were included; n = 261. Elevated NT-proBNP levels were defined as > or =500 pg/ml. Firstly, we assessed the relationship between COPD and NT-proBNP levels. Secondly, we investigated the association between elevated NT-proBNP levels and one-year mortality. COPD was independently associated with elevated NT-proBNP levels (OR 3.36, 95%CI 1.30-8.65) with significant associations found for mild and severe COPD. Elevated NT-proBNP levels were associated with increased one-year mortality in patients with (HR 7.73, 95%CI 1.60-37.43) and without COPD (HR 3.44, 95%CI 1.10-10.73). COPD was associated with elevated NT-proBNP levels in patients with a normal LVEF undergoing vascular surgery. Elevated NT-proBNP levels independent of other well-established risk factors were associated with increased one-year mortality. NT-proBNP may be useful biomarker to risk stratify patients with COPD.
authors.affiliation: Department of Anaesthesiology, Erasmus Medical Center, Rotterdam, The Netherlands. y.vangestel@erasmusmc.nl
authors.forename: Yvette R B M
authors.initials: YR
authors.lastname: van Gestel
authors.forename: Dustin
authors.initials: D
authors.lastname: Goei
authors.forename: Sanne E
authors.initials: SE
authors.lastname: Hoeks
authors.forename: Don D
authors.initials: DD
authors.lastname: Sin
authors.forename: Willem-Jan
authors.initials: WJ
authors.lastname: Flu
authors.forename: Henk
authors.initials: H
authors.lastname: Stam
authors.forename: Frans W
authors.initials: FW
authors.lastname: Mertens
authors.forename: Jeroen J
authors.initials: JJ
authors.lastname: Bax
authors.forename: Ron T
authors.initials: RT
authors.lastname: van Domburg
authors.forename: Don
authors.initials: D
authors.lastname: Poldermans
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D016022:Case-Control Studies; D015331:Cohort Studies; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D011237:Predictive Value of Tests; D029424:Pulmonary Disease, Chronic Obstructive / Q000097:blood* / Q000503:physiopathology / Q000601:surgery*; D012720:Severity of Illness Index; D016019:Survival Analysis; D014656:Vascular Surgical Procedures; D016277:Ventricular Function, Left / Q000502:physiology*
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain