Ability of B-Type Natriuretic Peptide in Predicting Postoperative Atrial Fibrillation in Patients Undergoing Coronary Artery Bypass Grafting
DOI:
https://doi.org/10.1532/HSF98.20091014Abstract
Objectives: Atrial fibrillation (AF) is still the most frequent rhythm disturbance after coronary artery surgery. Our aim was to evaluate the predictive value of preoperative brain natriuretic peptide (BNP) levels for determining postoperative new-onset AF in patients undergoing isolated first-time coronary artery bypass grafting (CABG) using cardiopulmonary bypass (CPB).
Methods: We recruited 144 consecutive patients (51 women and 93 men) who underwent isolated CABG. Preoperative and postoperative data were collected. Preoperative BNP levels were measured the day before surgery.
Results: The median preoperative BNP level was 68 pg/mL. Postoperative AF occurred in 36 (25%) of the patients. Univariate analyses showed that both advanced age and median preoperative BNP levels were associated with postoperative AF (63.9 ± 8 years versus 57.3 ± 9.8 years, P < .001; 226 pg/mL versus 65.2 pg/mL, P <.001). Both variables remained independent predictors of postoperative AF after multivariate logistic regression analyses. For advanced age, the odds ratio was 1.074 (95% confidence interval [CI], 1.019-1.131; P = .008); for preoperative BNP level, the odds ratio was 1.004 (95% CI, 1.001-1.006; P = .002). A receiver operating characteristic (ROC) curve demonstrated that preoperative BNP level was a predictor of postoperative AF, with an area under the ROC curve of 0.750. A cutoff value of 135 pg/mL for AF demonstrated a 72.2% sensitivity, a 71.2% specificity, a 45.6% positive predictive value, a 88.5% negative predictive value, and a 71.5% accuracy for predicting postoperative AF.
Conclusions: Elevated preoperative BNP levels and advanced age together are significant predictors for the development of postoperative AF in patients undergoing isolated CABG with CPB.
References
Aranki SF, Shaw DP, Adams DH, et al. 1996. Predictors of atrial fibrillation after coronary artery surgery. Current trends and impact on hospital resources. Circulation 94:390-7.nBettencourt 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.nCosgrave J, Foley JB, McGovern E, et al. 2006. Brain natriuretic peptide elevation and the development of atrial fibrillation following coronary artery bypass surgery. Interact Cardiovasc Thorac Surg 5:111-4.nCreswell LL, Schuessler RB, Rosenbloom M, Cox JL. 1993. Hazards of postoperative atrial arrhythmias. Ann Thorac Surg 56:539-49.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.nDorge H, Schoendube FA, Schoberer M, Stellbrink C, Voss M, Messmer BJ. 2000. Intraoperative amiodarone as prophylaxis against atrial fibrillation after coronary operations. Ann Thorac Surg 69:1358-62.nDucceschi V, D'Andrea A, Liccardo B, et al. 1999. Perioperative clinical predictors of atrial fibrillation occurrence following coronary artery bypass surgery. Eur J Cardiothorac Surg 16:435-9.nFerguson TB Jr, Smith LS, Smith PK, Damiano RJ, Cox JL. 1987. Electrical activity in the heart during hyperkalemic hypothermic cardioplegic arrest: site of origin and relationship to specialized conduction tissue. Ann Thorac Surg 43:373-9.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.nHakala T, Hedman A, Turpeinen A, Kettunen R, Vuolteenaho O, Hippeläinen M. 2002. Prediction of atrial fibrillation after coronary artery bypass grafting by measuring atrial peptide levels and preoperative atrial dimensions. Eur J Cardiothorac Surg 22:939-43.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.nKalman JM, Munawar M, Howes LG, et al. 1995. Atrial fibrillation after coronary artery bypass grafting is associated with sympathetic activation. Ann Thorac Surg 60:1709-15.nKitzman DW, Edwards WD. 1990. Age-related changes in the anatomy of the normal heart. J Gerontol 45:33-9.nLeitch JW, Thomson D, Baird DK, Harris PJ. 1990. The importance of age as a predictor of atrial fibrillation and flutter after coronary artery bypass grafting. J Thorac Cardiovasc Surg 100:338-42.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.nMathew JP, Parks R, Savino JS, et al. 1996. Atrial fibrillation following coronary artery bypass graft surgery: predictors, outcomes, and resource utilization. MultiCenter Study of Perioperative Ischemia Research Group. JAMA 276:300-6.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.nMoulton MJ, Creswell LL, Mackey ME, Cox JL, Rosenbloom M. 1996. Reexploration for bleeding is a risk factor for adverse outcomes after cardiac operations. J Thorac Cardiovasc Surg 111:1037-46.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.nPfisterer ME, Klöter-Weber UC, Huber M, et al. 1997. Prevention of supraventricular tachyarrhythmias after open heart operation by low-dose sotalol: a prospective, double-blind, randomized, placebo-controlled study. Ann Thorac Surg 64:1113-9.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.nRousou JA, Meeran MK, Engelman RM, Breyer RH, Lemeshow S. 1985. Does the type of venous drainage or cardioplegia affect postoperative conduction and atrial arrhythmias? Circulation 72:II 259-63.nTurk T, Ata Y, Ay D, et al. 2008. Plasma brain natriuretic peptide after isolated on-pump coronary artery bypass grafting: prediction of postoperative adverse outcomes. Heart Surg Forum 11:84-9.nTurk T, Vural H, Eris C, Ata Y, Yavuz S. 2007. Atrial fibrillation after off-pump coronary artery surgery: a prospective, matched study. J Int Med Res 35:134-42.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.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.nWhite HD, Antman EM, Glynn MA, et al. 1984. Efficacy and safety of timolol for prevention of supraventricular tachyarrhythmias after coronary artery bypass surgery. Circulation 70:479-84.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
