title: Differential Release Kinetics of Cardiac Biomarkers in Patients Undergoing Valve Replacement Surgery.
abstract: BACKGROUND
  Differential release kinetics of cardiac biomarkers including brain natriuretic peptide (BNP), Troponin-I, and CK-MB following valve replacement (VR) are not well characterized.
  
  
  RESULTS
  We serially measured these biomarkers 24 hours prior, six hours, 24 hours, 48 hours, and one month following mitral/aortic VR in 100 patients. Baseline BNP, Tn-I, and CK-MB levels were 304.01 pg/mL, 0.03 ng/mL, and 0.99 ng/mL, respectively. While BNP levels decreased at six hours, and then peaked at 24 hours, Tn-I and CK-MB levels increased within six hours and then showed declining trends by 24 hours. While Tn-I and CK-MB levels normalized at one month, 33% patients still had BNP >200 pg/mL. Those with baseline BNP >200 pg/mL more commonly had AF, higher RV systolic pressure, longer inotrope and ventilator duration, and longer mean ICU/hospital stay as compared to those with lower BNP, although echocardiographic left ventricular ejection fraction and Tn-I/CK-MB levels were similar. Inotrope duration >42 hours, ventilation time >29 hours, and ICU stay >4 days was seen in 42% versus 19%, 30% versus 9%, and 33% versus 14%, respectively, in those with BNP >/<200 pg/mL. Baseline BNP had a significant positive correlation with mean inotrope duration, ICU, and hospital stay. Baseline BNP was also a significant predictor of inotrope duration (odds ratio [OR]=5.9, 95% confidence interval [CI]=1.20-29.68, p=0.01) and ventilation time (OR=4.7, 95% CI=1.76-17.21, p=0.02).
  
  
  CONCLUSIONS
  Release kinetics of cardiac biomarkers is significantly different following VR; BNP levels increase following an initial transient decline. Only BNP was a predictor of postoperative variables.
authors.forename: Satyajit
authors.initials: S
authors.lastname: Singh
authors.forename: Aditya
authors.initials: A
authors.lastname: Kapoor
authors.forename: Surendra K
authors.initials: SK
authors.lastname: Agarwal
authors.forename: Shantanu
authors.initials: S
authors.lastname: Pande
authors.forename: Archana
authors.initials: A
authors.lastname: Sinha
authors.forename: Himanshu
authors.initials: H
authors.lastname: Rai
mesh_terms: D000328:Adult; D001021:Aortic Valve / Q000601:surgery*; D001281:Atrial Fibrillation; D015415:Biomarkers / Q000097:blood; D052279:Creatine Kinase, MB Form / Q000097:blood; D005260:Female; D005544:Forecasting; D006349:Heart Valve Diseases / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D007902:Length of Stay; D008297:Male; D008943:Mitral Valve / Q000601:surgery*; D009200:Myocardial Contraction; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D059035:Perioperative Period; D011379:Prognosis; D011446:Prospective Studies; D012121:Respiration, Artificial; D013318:Stroke Volume; D013599:Systole; D013997:Time Factors; D019210:Troponin I / Q000097:blood; D016277:Ventricular Function, Left; D055815:Young Adult
chemical_list: D015415:Biomarkers; D019210:Troponin I; D020097:Natriuretic Peptide, Brain; D052279:Creatine Kinase, MB Form