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EDITORIAL

Clinical value of BNP as an independent predictor of mortality following heart surgery

Edmo Atique Gabriel

DOI: 10.5935/1678-9741.20150025

Detection and characterization of mortality predictors is becoming an interesting approach in the field of cardiovascular surgery, particularly in valve and CABG procedures. Yet there is a paucity of trials in order to obtain precise data on this topic using statistic criteria. In the last decades, many cardiologists have turned attention to underlying role of inflammation in heart diseases and different types of heart operation. The key point raised by these experts is that main expression from inflammatory cardiovascular process can be translated into serologic appearance of some markers[1-3].

From the publication "Predictors of mortality in cardiac surgery: B-type natriuretic peptide" by Murad Junior et al.[4], the first observation can be drawn is epidemiologic quality of retrospective study of valve and CABG patients. Undoubtedly main step for identifying a mortality predictor using statistical analysis is to know how patients were selected and included in the study.

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The second and most remarkable observation can be drawn from publication by Murad Junior et al.[4] is the meticulous view regarding preoperative role of BNP as a mortality predictor in the setting of valve and CABG operations. Many authors have advocated that cardiac diseases have some inflammatory burden preoperatively and, on account of it, postoperative time becomes a particular moment for so many complications and deleterious events[5-7].

This study provides a very elegant representation of preoperative BNP values and its relationship with 30-day mortality. Thus, publication by Murad et al.[4] is a cornerstone reference for brazilian cardiologic community in an attempt to preoperatively include BNP as prognostic marker in valve and CABG operations.

REFERENCES

1. Sudoh T, Kangawa K, Minamino N, Matsuo H. A new natriuretic peptide in porcine brain. Nature. 1988;332(6159):78-81. [MedLine]

2. Augusto CA, Vicente WVA, Evora PRB, Rodrigues AJ, Klamt JG, Carlotti APCP et al. High-dose aprotinin does not affect troponin I, N-terminal pro-B-type natriuretic peptide and renalfunction in children submitted to surgical correction with extracorporeal circulation. Rev Bras Cir Cardiovasc 2009;24(4):519-32. [MedLine]

3. Gabriel EA, Locali RF, Matsuoka PK, Almeida LS, Silva PSV, Ishigai MMS, Salerno T, Buffolo E. Pulmonary artery perfusion does not improve brain natriuretic peptide (BNP) levels in suine experimental research. Rev Bras Cir Cardiovasc 2010;25(4):516-26. [MedLine] View article

4.Murad Junior JA, Nakazone MA, Machado MN, Godoy MF. Predictors of mortality in cardiac surgery: B-type natriuretic peptide. Rev Bras Cir Cardiovasc. 2015;30(2):182-7.

5. Suzuki S, Yoshimura M, Nakayama M, Harada E, Ito T, Nakamura S, et al. Plasma level of B-type natriuretic peptide a prognostic marker after acute myocardial infarction a long-term follow-up analysis. Circulation. 2004;110(11):1387-91. [MedLine]

6. Hartmann F, Packer M, Coats AJ, Fowler MB, Krum H, Mohacsi P, Rouleau HA. Prognostic impact of plasma n-terminal pro-brain natriuretic peptide in severe chroniccongestive heart failure: a sustudy of the carvedilol prospective randomizaed cumulative survival (COPERNICUS) trial. Circulation. 2004;110(13):1780-6. [MedLine]

7. Fellahi JL, Dacache G, Rubes D, Masseti M, Gérard JL, Hanouz JL. Does preoperative B-type natriuretic peptide better predict adverse outcome and prolonged length of stay than the standard European system for cardiac operative risk evaluation after cardiac surgery? J Cardiothorac Vasc Anesth. 2010 july 29; [Epub ahead of print].

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