Plasma Brain Natriuretic Peptide after Isolated On-Pump Coronary Artery Bypass Grafting: Prediction of Postoperative Adverse Outcomes


  • Tamer Turk
  • Yusuf Ata
  • Derih Ay
  • Hakan Ozkan
  • Hakan Vural
  • Senol Yavuz
  • Ahmet Ozyazicioglu



Background. The heart is an endocrine organ that synthesizes 2 different natriuretic peptides: atrial natriuretic peptide and brain natriuretic peptide (BNP). We assessed the relationship between preoperative BNP levels and postoperative complications and outcomes in patients who undergo isolated coronary artery bypass grafting (CABG).

Method and Results. The study consisted of 85 patients undergoing first-time elective CABG. Preoperative BNP levels were significantly correlated with the preoperative ejection fraction (P = .004), the number of vessels grafted (P = .016), cross-clamp time (P = .041), and perfusion time (P = .032). Preoperative BNP levels were higher in patients who developed postoperative new-onset atrial fibrillation (AF) (median BNP, 197 pg/mL versus 65 pg/mL; P = .006), in patients requiring inotropic support (189 pg/mL versus 65 pg/mL; P = .004), and in patients who required an intra-aortic balloon pump (IABP) (325 pg/mL versus 68 pg/mL; P= .021). Analysis of receiver operating characteristic curves demonstrated the preoperative BNP level to be a predictor of new-onset AF, a need for inotropic support, and a requirement for an IABP (areas under the curve, 0.70, 0.70, and 0.79, respectively). BNP cutoff values of 100 pg/mL for AF, 185 pg/mL for inotropic support, and 235 pg/mL for requiring an IABP predicted these postoperative adverse outcomes with 65%, 73%, and 84% accuracy, respectively.

Conclusion. This study suggests that a higher baseline plasma BNP concentration is associated with postoperative new-onset AF, a need for inotropic support, and an IABP requirement in patients who undergo first-time isolated CABG.


Bettencourt P, Ferreira S, Azevedo A, Ferreira A. 2002. Preliminary data on the potential usefulness of B-type natriuretic peptide levels in predicting outcome after hospital discharge in patients with heart failure. Am J Med 113:215-9.nCheng V, Kazanagra R, Garcia A, et al. 2001. A rapid bedside test for B-type peptide predicts treatment outcomes in patients admitted for decompensated heart failure: a pilot study. J Am Coll Cardiol 37:386-91.nDao Q, Krishnaswamy P, Kazanegra R, et al. 2001. Utility of B-type natriuretic peptide in the diagnosis of congestive heart failure in an urgent-care setting. J Am Coll Cardiol 37:379-85.nDupuis JY, Wang F, Nathan H, Lam M, Grimes S, Bourke M. 2001. The cardiac anesthesia risk evaluation score: a clinically useful predictor of mortality and morbidity after cardiac surgery. Anesthesiology 94:194-204.nFrancis GS, Benedict C, Johnstone DE, et al. 1990. Comparison of neuroendocrine activation in patients with left ventricular dysfunction with and without congestive heart failure: a substudy of the Studies of Left Ventricular Dysfunction (SOLVD). Circulation 82:1724-9.nGottlieb SS, Kukin ML, Ahern D, Packer M. 1989. Prognostic importance of atrial natriuretic peptide in patients with chronic heart failure. J Am Coll Cardiol 13:1534-9.nHiggins TL, Estafanous FG, Loop FD, Beck GJ, Blum JM, Paranandi L. 1992. Stratification of morbidity and mortality outcome by preoperative risk factors in coronary artery bypass patients: a clinical severity score. JAMA 267:2344-8.nHutfless R, Kazanegra R, Madani M, et al. 2004. Utility of B-type natriuretic peptide in predicting postoperative complications and outcomes in patients undergoing heart surgery. J Am Coll Cardiol 43:1873-9.nKrishnaswamy P, Lubien E, Clopton P, et al. 2001. Utility of B-natriuretic peptide levels in identifying patients with left ventricular systolic or diastolic dysfunction. Am J Med 111:274-9.nMaeda K, Tsutamoto T, Wada A, Hisanaga T, Kinoshita M. 1998. Plasma brain natriuretic peptide as a biochemical marker of high left ventricular end-diastolic pressure in patients with symptomatic left ventricular dysfunction. Am Heart J 135:825-32.nMaisel A. 2001. B-type natriuretic peptide levels: diagnostic and therapeutic potential. Cardiovasc Toxicol 1:159-64.nMaisel AS, Krishnaswamy P, Nowak RM, et al., for the Breathing Not Properly Multinational Study Investigators. 2002. Rapid measurement of B-type natriuretic peptide in the emergency diagnosis of heart failure. N Engl J Med 347:161-7.nMartinez-Alario J, Tuesta ID, Plasencia E, Santana M, Mora ML. 1999. Mortality prediction in cardiac surgery patients: comparative performance of Parsonnet and general severity systems. Circulation 99:2378-82.nMcCullough PA, Nowak RM, McCord J, et al. 2002. B-type natriuretic peptide and clinical judgment in emergency diagnosis of heart failure: analysis from Breathing Not Properly (BNP) Multinational Study. Circulation 106:416-22.nMorita E, Yasue H, Yoshimura M, et al. 1993. Increased plasma levels of brain natriuretic peptide in patients with acute myocardial infarction. Circulation 88:82-91.nNozaki N, Yamaguchi S, Shirakabe M, Nakamura H, Tomoike H. 1997. Soluble tumor necrosis factor receptors are elevated in relation to severity of congestive heart failure. Jpn Circ J 61:657-64.nOmland T, Persson A, Ng L, et al. 2002. N-terminal pro-B-type natriuretic peptide and long-term mortality in acute coronary syndromes. Circulation 106:2913-8.nParsonnet V, Dean D, Bernstein AD. 1989. A method of uniform stratification of risk for evaluating the results of surgery in acquired adult heart disease. Circulation 79:13-12.nPons JM, Espinas JA, Borras JM, Moreno V, Martin I, Granados A. 1998. Cardiac surgical mortality: comparison among different additive risk-scoring models in a multicenter sample. Arch Surg 133:1053-7.nProvenchere S, Berroeta C, Reynaud C, et al. 2006. Plasma brain natriuretic peptide and cardiac troponin I concentrations after adult cardiac surgery: association with postoperative cardiac dysfunction and 1-year mortality. Crit Care Med 34:995-1000.nRichards AM, Nicholls MG, Espiner EA, et al. 2003. B-type natriuretic peptides and ejection fraction for prognosis after myocardial infarction. Circulation 107:2786-92.nSaribulbul O, Alat I, Coskun S, et al. 2003. The role of brain natriuretic peptide in the prediction of cardiac performance in coronary artery bypass grafting. Tex Heart Inst J 30:298-304.nShirasawa B, Hamano K, Kawamura T, et al. 2000. Does the serum brain natriuretic peptide (BNP) level after open heart surgery reflect myocardial protection? [in Japanese]. Kyobu Geka 53:123-6.nTroughton RW, Frampton CM, Yandle TG, Espiner EA, Nicholls MG, Richards AM. 2000. Treatment of heart failure guided by plasma aminoterminal brain natriuretic peptide (N-BNP) concentrations. Lancet 355:1126-30.nTu JV, Jaglal SB, Naylor CD. 1995. Multicenter validation of a risk index for mortality, intensive care unit stay, and overall hospital length of stay after cardiac surgery. Steering Committee of the Provincial Adult Cardiac Care Network of Ontario. Circulation 91:677-84.nTuman KJ, McCarthy RJ, March RJ, Najafi H, Lvankovich AD. 1992. Morbidity and duration of ICU stay after cardiac surgery: a model for preoperative risk assessment. Chest 102:36-44.nWazni OM, Martin DO, Marrouche NF, et al. 2004. Plasma B-type natriuretic peptide levels predict postoperative atrial fibrillation in patients undergoing cardiac surgery. Circulation 110:124-7.nWeightman WM, Gibbs NM, Sheminant MR, Thackray NM, Newman MA. 1997. Risk prediction in coronary artery surgery: a comparison of four risk scores. Med J Aust 166:408-11.nWendelboe Nielsen O, Kirk V, Bay M, Boesgaard S, Nielsen H. 2004. Value of N-terminal pro brain natriuretic peptide in the elderly: data from the prospective Copenhagen Hospital Heart Failure study (CHHF). Eur J Heart Fail 6:275-9.nYasue H, Yoshimura M, Sumida H, et al. 1994. Localization and mechanism of secretion of B-type natriuretic peptide in comparison with those of A-type natriuretic peptide in normal subjects and patients with heart failure. Circulation 90:195-203.n



How to Cite

Turk, T., Ata, Y., Ay, D., Ozkan, H., Vural, H., Yavuz, S., & Ozyazicioglu, A. (2008). Plasma Brain Natriuretic Peptide after Isolated On-Pump Coronary Artery Bypass Grafting: Prediction of Postoperative Adverse Outcomes. The Heart Surgery Forum, 11(2), E84-E89.