A Potential Marker for Prognosis in Giant Left Ventricular Patients Undergoing Valve Surgery
DOI:
https://doi.org/10.1532/hsf.5623Keywords:
giant left ventricle, valve disease, surgery, prognosisAbstract
Background: Although many clinicians have made efforts to improve the prognosis for giant left ventricular with valve disease patients, potential markers to judge the prognosis of giant left ventricular patients undergoing valve surgery are still unknown. The purpose of this study was to explore the possible impact factors for giant left ventricle prognosis. Methods: From September 2019 to September 2022, 75 patients with preoperative valvular disease with a giant left ventricle (left ventricular end diastolic diameter (LVEDD) >65 mm) underwent cardiac valve surgery. The changes in cardiac function one year after surgery were used to describe prognosis and analyze the potential independent factors affecting surgical prognosis. The left ventricular ejection fraction (LVEF) was considered to be recovered if it was ≥50% on follow-up echocardiography at least 6 months after the diagnosis. Results: The cardiac function of patients with a giant left ventricular and valve disease improved. Compared with preoperation, the left ventricular end diastolic diameter (LVEDD), left ventricular end-systolic dimension (LVESD), pulmonary artery systolic pressure (PASP), NT-proBNP, and cardio thoracic ratio (CTR) were significantly decreased (p < 0.05), and the ratio of severe heart failure was decreased from 60% to 37.33%. In the univariate analyses, the preoperative NT-proBNP levels and PASP were significantly associated with the cardiac function recovery (odds ratio [OR] = 1.001, 95% CI 1.000–1.002, p = 0.027; OR = 1.092, 95% CI 1.015–1.175, p = 0.018). However, during the diagnostic test, PASP did not account for cardiac function recovery (AUROC = 0.505, 95% CI = 0.387–0.713, p = 0.531). Based on the cutoff value in the experiment, we found that a NT-proBNP >753 pg/mL (AUROC = 0.851, 95% CI = 0.757–0.946, p < 0.0001) was a potential prognostic marker for patients with a giant left ventricular valve disease. Conclusions: We have demonstrated that an elevated preoperative NT-proBNP level is an independent predictor of cardiac function recovery in a cohort of giant left ventricular patients undergoing valve surgery, and this is the first study about this specific cohort of patients.
References
Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP 3rd, Guyton RA, et al. 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines [published correction appears in Circulation. 2014; 129: e650]. Circulation. 2014; 129: 2440–2492.
Zhang H, Xu HS, Wen B, Zhao WZ, Liu C. Minimally invasive beating heart technique for mitral valve surgery in patients with previous sternotomy and giant left ventricle. Journal of Cardiothoracic Surgery. 2020; 15: 122.
Han D, Zhang Y, Xue DM, Wang WL, Yan WJ. Valve replacement for valvular heart disease with giant left ventricle. European Review for Medical and Pharmacological Sciences. 2015; 19: 3001–3005.
Sanz J, Sánchez-Quintana D, Bossone E, Bogaard HJ, Naeije R. Anatomy, Function, and Dysfunction of the Right Ventricle: JACC State-of-the-Art Review. Journal of the American College of Cardiology. 2019; 73: 1463–1482.
Ross J, Jr. Left ventricular function and the timing of surgical treatment in valvular heart disease. Annals of Internal Medicine. 1981; 94: 498–504.
Lomivorotov VV, Efremov SM, Kirov MY, Fominskiy EV, Karaskov AM. Low-Cardiac-Output Syndrome After Cardiac Surgery. Journal of Cardiothoracic and Vascular Anesthesia. 2017; 31: 291–308.
Buckberg G, Athanasuleas C, Conte J. Surgical ventricular restoration for the treatment of heart failure. Nature Reviews. Cardiology. 2012; 9: 703–716.
Liang YD, Xu YW, Li WH, Wan K, Sun JY, Lin JY, et al. Left ventricular function recovery in peripartum cardiomyopathy: a cardiovascular magnetic resonance study by myocardial T1 and T2 mapping. Journal of Cardiovascular Magnetic Resonance. 2020; 22: 2.
Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pellikka PA, et al. Recommendations for chamber quantification: a report from the American Society of Echocardiography's Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. Journal of the American Society of Echocardiography. 2005; 18: 1440–1463.
Allen HD, Lange LW, Sahn DJ, Goldberg SJ. Ultrasound cardiac diagnosis. Pediatric Clinics of North America. 1978; 25: 677–706.
Caenen A, Pernot M, Nightingale KR, Voigt JU, Vos HJ, Segers P, et al. Assessing cardiac stiffness using ultrasound shear wave elastography. Physics in Medicine and Biology. 2022; 67.
Pedrizzetti G, Claus P, Kilner PJ, Nagel E. Principles of cardiovascular magnetic resonance feature tracking and echocardiographic speckle tracking for informed clinical use. Journal of Cardiovascular Magnetic Resonance. 2016; 18: 51.
de Boer RA, Daniels LB, Maisel AS, Januzzi JL, Jr. State of the Art: Newer biomarkers in heart failure. European Journal of Heart Failure. 2015; 17: 559–569.
López B, González A, Ravassa S, Beaumont J, Moreno MU, San José G, et al. Circulating Biomarkers of Myocardial Fibrosis: The Need for a Reappraisal. Journal of the American College of Cardiology. 2015; 65: 2449–2456.
Ma J, Xin Q, Wang X, Gao M, Wang Y, Liu J. Prediction of perioperative cardiac events through preoperative NT-pro-BNP and cTnI after emergent non-cardiac surgery in elderly patients. PLoS ONE. 2015; 10: e0121306.
Fox AA, Shernan SK, Collard CD, Liu KY, Aranki SF, DeSantis SM, et al. Preoperative B-type natriuretic peptide is as independent predictor of ventricular dysfunction and mortality after primary coronary artery bypass grafting. The Journal of Thoracic and Cardiovascular Surgery. 2008; 136: 452–461.
Fox AA, Body SC. Assessment of preoperative B-type natriuretic peptide in adult surgeries: is it useful? Anesthesia and Analgesia. 2011; 112: 1005–1007.
Nojiri T, Maeda H, Takeuchi Y, Funakoshi Y, Kimura T, Maekura R, et al. Predictive value of B-type natriuretic peptide for postoperative atrial fibrillation following pulmonary resection for lung cancer. European Journal of Cardio-Thoracic Surgery. 2010; 37: 787–791.
Goei D, Flu WJ, Hoeks SE, Galal W, Dunkelgrun M, Boersma E, et al. The interrelationship between preoperative anemia and N-terminal pro-B-type natriuretic peptide: the effect on predicting postoperative cardiac outcome in vascular surgery patients. Anesthesia and Analgesia. 2009; 109: 1403–1408.
Rodseth RN, Padayachee L, Biccard BM. A meta-analysis of the utility of pre-operative brain natriuretic peptide in predicting early and intermediate-term mortality and major adverse cardiac events in vascular surgical patients. Anaesthesia. 2008; 63: 1226–1233.
