Prognostic value of preoperative N-terminal pro-brain natriuretic peptide in non-cardiac surgery of elderly patients with normal left ventricular systolic function.
OBJECTIVE
We investigated the prognostic value of preoperative N-terminal pro-brain natriuretic peptide (NT-proBNP) in non-cardiac surgery in elderly patients who showed normal left ventricular function on preoperative echocardiography.


METHODS
We analyzed 1459 patients aged older than 70 years who had consulted a cardiologist for the evaluation of cardiovascular risk for non-cardiac surgery. Of the 721 patients who simultaneously underwent echocardiography and NT-proBNP assessments, 506 who showed normal left ventricular systolic function were included. The predictive power of NT-proBNP for the risk of major adverse cardiac and cerebrovascular events (MACCE) was evaluated.


RESULTS
MACCE occurred in 40 (7.9%) of the 506 patients, and the median value of NT-proBNP was higher in patients with complications than in those without (MACCE group: 1700.5 pg/mL vs non MACCE group: 206.35 pg/mL; P < 0.001). The area under the receiver operating characteristic curve was 0.804 (P < 0.001), with an optimal cut-off of 425.3 pg/mL. Multivariate analysis showed that increased NT-proBNP (>425.3 pg/mL; odds ratio 6.381; P < 0.001) was the only independent risk factor for the prediction of MACCE.


CONCLUSIONS
In elderly patients who showed normal left ventricular systolic function on echocardiography, measurement of preoperative NT-proBNP concentration might be a useful test for predicting the occurrence of MACCE after non-cardiac surgery. Geriatr Gerontol Int 2016; 16: 1109-1116.
Department of Cardiology, CHA Bundang Medical Center, CHA University, Seongnam, Korea.
In Jai
IJ
Kim
Department of Cardiology, CHA Bundang Medical Center, CHA University, Seongnam, Korea. answod77@naver.com.
Jae Youn
http://orcid.org/0000-0001-8775-3539
JY
Moon
Department of Cardiology, CHA Bundang Medical Center, CHA University, Seongnam, Korea.
Eun-Jung
EJ
Ko
Department of Cardiology, CHA Bundang Medical Center, CHA University, Seongnam, Korea.
Yeong-Min
YM
Lim
Department of Cardiology, CHA Bundang Medical Center, CHA University, Seongnam, Korea.
Sang Hoon
SH
Kim
Department of Cardiology, CHA Bundang Medical Center, CHA University, Seongnam, Korea.
Woo-In
WI
Yang
Department of Cardiology, CHA Bundang Medical Center, CHA University, Seongnam, Korea.
Jung-Hoon
JH
Sung
Department of Cardiology, CHA Bundang Medical Center, CHA University, Seongnam, Korea.
Sang-Wook
SW
Lim
Department of Cardiology, CHA Bundang Medical Center, CHA University, Seongnam, Korea.
Dong-Hun
DH
Cha
D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D002318:Cardiovascular Diseases / Q000175:diagnosis* / Q000453:epidemiology; D015331:Cohort Studies; D004452:Echocardiography / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D016017:Odds Ratio; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology; D011237:Predictive Value of Tests; D011300:Preoperative Care / Q000379:methods*; D011379:Prognosis; D012372:ROC Curve; D018570:Risk Assessment; D013514:Surgical Procedures, Operative / Q000009:adverse effects* / Q000379:methods; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging; D016277:Ventricular Function, Left / Q000502:physiology*
D015415:Biomarkers; D020097:Natriuretic Peptide, Brain
N-terminal pro-brain natriuretic peptide; echocardiography; elderly; heart failure; non-cardiac surgery