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Clemente Gouveia de Gramilho GM, Pereira-Macedo J, Dias LRP, Dias Ferreira AR, Myrcha P, Alves Vieira Andrade JP, Rocha-Neves JMPD. Brain natriuretic peptide is a long-term cardiovascular predictor in carotid endarterectomy. Acta Chir Belg 2024:1-7. [PMID: 38975870 DOI: 10.1080/00015458.2024.2377889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Accepted: 07/04/2024] [Indexed: 07/09/2024]
Abstract
BACKGROUND In noncardiac surgery, several biomarkers are known to play a role in predicting long-term complications, such as major adverse cardiovascular events (MACE), myocardial infarction, or death. Carotid endarterectomy (CEA) is considered a low to medium-risk surgery for carotid stenosis aimed at preventing stroke events. Brain natriuretic peptide (BNP) is a biomarker with potential prognostic value regarding MACE. Since its role in patients undergoing CEA is unknown, this study aims to assess the potential role of BNP as a short and long-term predictor of all-cause mortality and MACE in patients undergoing CEA. METHODS From a prospective database, patients who underwent CEA under regional anesthesia (RA) at a tertiary hospital center were enrolled, and a post hoc analysis was conducted. Patients on which BNP levels were measured up to fifteen days before surgery, and two groups based on the BNP threshold (200 pg/mL) were defined and compared. Kaplan Meier survival curves and adjusted hazard ratios (aHR) were assessed by multivariable Cox regression. The primary outcome was the incidence of long-term MACE and all-cause mortality. Secondary outcomes included the incidence of AMI and AHF. RESULTS A total of 89 patients were evaluated. The mean age of the cohort was 71.2 ± 8.7 years, with 71 (79.8%) males, and presented a median follow-up of 30 [13.5-46.4] months. BNP > 200 pg/mL has demonstrated positive predictive value for MACE (aHR: 5.569, confidence interval (CI): 2.441-12.7, p < 0.001) and all-cause mortality (aHR: 3.469, CI: 1.315-9.150, p = 0.018). CONCLUSION BNP has been demonstrated to independently predict long-term all-cause mortality, MACE and AMI following CEA. It serves as a low-cost, ready-to-use biomarker, although further studies are necessary.
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Affiliation(s)
| | - Juliana Pereira-Macedo
- Faculdade de Medicina da Universidade do Porto, Porto, Portugal
- Department of Surgery, Unidade Local de Saúde do Médio Ave, Vila Nova de Famalicão, Portugal
- RISE@Heath, Porto, Portugal
| | - Lara Romana Pereira Dias
- Department of Angiology and Vascular Surgery, Unidade Local de Saúde de São João, Porto, Portugal
| | - Ana Rita Dias Ferreira
- Intensive Care Medicine Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Piotr Myrcha
- Department of General and Vascular Surgery, Faculty of Medicine, Medical University of Warsaw, Warsaw, Poland
- Department of General, Vascular and Oncological Surgery, Brodnowski Hospital, Warsaw, Poland
| | - José Paulo Alves Vieira Andrade
- RISE@Heath, Porto, Portugal
- Unit of Anatomy, Department of Biomedicine, Faculty of Medicine, University of Porto, Porto, Portugal
| | - João Manuel Palmeira da Rocha-Neves
- RISE@Heath, Porto, Portugal
- Department of Angiology and Vascular Surgery, Unidade Local de Saúde de São João, Porto, Portugal
- Unit of Anatomy, Department of Biomedicine, Faculty of Medicine, University of Porto, Porto, Portugal
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Vernooij LM, van Klei WA, Moons KG, Takada T, van Waes J, Damen JA. The comparative and added prognostic value of biomarkers to the Revised Cardiac Risk Index for preoperative prediction of major adverse cardiac events and all-cause mortality in patients who undergo noncardiac surgery. Cochrane Database Syst Rev 2021; 12:CD013139. [PMID: 34931303 PMCID: PMC8689147 DOI: 10.1002/14651858.cd013139.pub2] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The Revised Cardiac Risk Index (RCRI) is a widely acknowledged prognostic model to estimate preoperatively the probability of developing in-hospital major adverse cardiac events (MACE) in patients undergoing noncardiac surgery. However, the RCRI does not always make accurate predictions, so various studies have investigated whether biomarkers added to or compared with the RCRI could improve this. OBJECTIVES Primary: To investigate the added predictive value of biomarkers to the RCRI to preoperatively predict in-hospital MACE and other adverse outcomes in patients undergoing noncardiac surgery. Secondary: To investigate the prognostic value of biomarkers compared to the RCRI to preoperatively predict in-hospital MACE and other adverse outcomes in patients undergoing noncardiac surgery. Tertiary: To investigate the prognostic value of other prediction models compared to the RCRI to preoperatively predict in-hospital MACE and other adverse outcomes in patients undergoing noncardiac surgery. SEARCH METHODS We searched MEDLINE and Embase from 1 January 1999 (the year that the RCRI was published) until 25 June 2020. We also searched ISI Web of Science and SCOPUS for articles referring to the original RCRI development study in that period. SELECTION CRITERIA We included studies among adults who underwent noncardiac surgery, reporting on (external) validation of the RCRI and: - the addition of biomarker(s) to the RCRI; or - the comparison of the predictive accuracy of biomarker(s) to the RCRI; or - the comparison of the predictive accuracy of the RCRI to other models. Besides MACE, all other adverse outcomes were considered for inclusion. DATA COLLECTION AND ANALYSIS We developed a data extraction form based on the CHARMS checklist. Independent pairs of authors screened references, extracted data and assessed risk of bias and concerns regarding applicability according to PROBAST. For biomarkers and prediction models that were added or compared to the RCRI in ≥ 3 different articles, we described study characteristics and findings in further detail. We did not apply GRADE as no guidance is available for prognostic model reviews. MAIN RESULTS We screened 3960 records and included 107 articles. Over all objectives we rated risk of bias as high in ≥ 1 domain in 90% of included studies, particularly in the analysis domain. Statistical pooling or meta-analysis of reported results was impossible due to heterogeneity in various aspects: outcomes used, scale by which the biomarker was added/compared to the RCRI, prediction horizons and studied populations. Added predictive value of biomarkers to the RCRI Fifty-one studies reported on the added value of biomarkers to the RCRI. Sixty-nine different predictors were identified derived from blood (29%), imaging (33%) or other sources (38%). Addition of NT-proBNP, troponin or their combination improved the RCRI for predicting MACE (median delta c-statistics: 0.08, 0.14 and 0.12 for NT-proBNP, troponin and their combination, respectively). The median total net reclassification index (NRI) was 0.16 and 0.74 after addition of troponin and NT-proBNP to the RCRI, respectively. Calibration was not reported. To predict myocardial infarction, the median delta c-statistic when NT-proBNP was added to the RCRI was 0.09, and 0.06 for prediction of all-cause mortality and MACE combined. For BNP and copeptin, data were not sufficient to provide results on their added predictive performance, for any of the outcomes. Comparison of the predictive value of biomarkers to the RCRI Fifty-one studies assessed the predictive performance of biomarkers alone compared to the RCRI. We identified 60 unique predictors derived from blood (38%), imaging (30%) or other sources, such as the American Society of Anesthesiologists (ASA) classification (32%). Predictions were similar between the ASA classification and the RCRI for all studied outcomes. In studies different from those identified in objective 1, the median delta c-statistic was 0.15 and 0.12 in favour of BNP and NT-proBNP alone, respectively, when compared to the RCRI, for the prediction of MACE. For C-reactive protein, the predictive performance was similar to the RCRI. For other biomarkers and outcomes, data were insufficient to provide summary results. One study reported on calibration and none on reclassification. Comparison of the predictive value of other prognostic models to the RCRI Fifty-two articles compared the predictive ability of the RCRI to other prognostic models. Of these, 42% developed a new prediction model, 22% updated the RCRI, or another prediction model, and 37% validated an existing prediction model. None of the other prediction models showed better performance in predicting MACE than the RCRI. To predict myocardial infarction and cardiac arrest, ACS-NSQIP-MICA had a higher median delta c-statistic of 0.11 compared to the RCRI. To predict all-cause mortality, the median delta c-statistic was 0.15 higher in favour of ACS-NSQIP-SRS compared to the RCRI. Predictive performance was not better for CHADS2, CHA2DS2-VASc, R2CHADS2, Goldman index, Detsky index or VSG-CRI compared to the RCRI for any of the outcomes. Calibration and reclassification were reported in only one and three studies, respectively. AUTHORS' CONCLUSIONS Studies included in this review suggest that the predictive performance of the RCRI in predicting MACE is improved when NT-proBNP, troponin or their combination are added. Other studies indicate that BNP and NT-proBNP, when used in isolation, may even have a higher discriminative performance than the RCRI. There was insufficient evidence of a difference between the predictive accuracy of the RCRI and other prediction models in predicting MACE. However, ACS-NSQIP-MICA and ACS-NSQIP-SRS outperformed the RCRI in predicting myocardial infarction and cardiac arrest combined, and all-cause mortality, respectively. Nevertheless, the results cannot be interpreted as conclusive due to high risks of bias in a majority of papers, and pooling was impossible due to heterogeneity in outcomes, prediction horizons, biomarkers and studied populations. Future research on the added prognostic value of biomarkers to existing prediction models should focus on biomarkers with good predictive accuracy in other settings (e.g. diagnosis of myocardial infarction) and identification of biomarkers from omics data. They should be compared to novel biomarkers with so far insufficient evidence compared to established ones, including NT-proBNP or troponins. Adherence to recent guidance for prediction model studies (e.g. TRIPOD; PROBAST) and use of standardised outcome definitions in primary studies is highly recommended to facilitate systematic review and meta-analyses in the future.
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Affiliation(s)
- Lisette M Vernooij
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
- Department of Anesthesiology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Wilton A van Klei
- Department of Anesthesiology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
- Anesthesiologist and R. Fraser Elliott Chair in Cardiac Anesthesia, Department of Anesthesia and Pain Management Toronto General Hospital, University Health Network and Professor, Department of Anesthesiology and Pain Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Karel Gm Moons
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
- Cochrane Netherlands, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Toshihiko Takada
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Judith van Waes
- Department of Anesthesiology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Johanna Aag Damen
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
- Cochrane Netherlands, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
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Yurttas T, Hidvegi R, Filipovic M. Biomarker-Based Preoperative Risk Stratification for Patients Undergoing Non-Cardiac Surgery. J Clin Med 2020; 9:jcm9020351. [PMID: 32012699 PMCID: PMC7074404 DOI: 10.3390/jcm9020351] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 01/21/2020] [Accepted: 01/24/2020] [Indexed: 12/22/2022] Open
Abstract
Perioperative morbidity and mortality remains a substantial problem and is strongly associated with patients’ cardiac comorbidities. Guidelines for the cardiovascular assessment and management of patients at risk of cardiac issues while undergoing non-cardiac surgery are traditionally based on the exclusion of active or unstable cardiac conditions, determination of the risk of surgery, the functional capacity of the patient, and the presence of cardiac risk factors. In the last two decades, strong evidence showed an association between cardiac biomarkers and adverse cardiac events, with newer guidelines incorporating this knowledge. This review describes a biomarker-based risk-stratification pathway and discusses potential treatment strategies for patients suffering from postoperative myocardial injury or infarction.
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A Risk Stratification Model for Cardiovascular Complications during the 3-Month Period after Major Elective Vascular Surgery. BIOMED RESEARCH INTERNATIONAL 2018; 2018:4381527. [PMID: 30271785 PMCID: PMC6151200 DOI: 10.1155/2018/4381527] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 08/01/2018] [Accepted: 08/15/2018] [Indexed: 12/28/2022]
Abstract
Introduction The Revised Cardiac Risk Index (RCRI) is an extensively used simple risk stratification tool advocated by the European Society of Cardiology and European Society of Anesthesiology (ESC/ESA). Purpose The aim of this study was to find the best model for predicting 3-month cardiovascular complications in elective major vascular surgical patients using preoperative clinical assessment, calculation of the RCRI and Vascular Physiological and Operative Severity Score for the enumeration of mortality and morbidity (V-POSSUM) scores, and the preoperative levels of N-terminal brain natriuretic peptide (NT pro-BNP), high-sensitivity troponin I (hs TnI), and high-sensitivity C-reactive protein (hs CRP). Materials and Methods We included 122 participants in a prospective, single-center, observational study. The levels of NT pro-BNP, hs CRP, and hs TnI were measured 48 hours prior to surgery. During the perioperative period and 90 days after surgery the following adverse cardiac events were recorded: myocardial infarction, arrhythmias, pulmonary edema, acute decompensated heart failure, and cardiac arrest. Results During the first 3 months after surgery 29 participants (23.8%) had 50 cardiac complications. There was a statistically significant difference in the RCRI score between participants with and without cardiac complications. ROC analysis showed that a combination of RCRI with hs TnI has good discriminatory power (AUC 0.909, p<0,001). By adding NT pro-BNP concentrations to the RCRI+hs TnI+V-POSSSUM combination we obtained the model with the best predictive power for 3-month cardiac complications (AUC 0.963, p<0,001). Conclusion We need to improve preoperative risk assessment in participants scheduled for major vascular surgery by combining their clinical scores with biomarkers. Therefore, it is possible to identify patients at risk of cardiovascular complications who need adequate preoperative diagnosis and treatment.
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Lyons MM, Bhatt NY, Kneeland-Szanto E, Keenan BT, Pechar J, Stearns B, Elkassabany NM, Memtsoudis SG, Pack AI, Gurubhagavatula I. Sleep apnea in total joint arthroplasty patients and the role for cardiac biomarkers for risk stratification: an exploration of feasibility. Biomark Med 2016; 10:265-300. [PMID: 26925513 DOI: 10.2217/bmm.16.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Obstructive sleep apnea (OSA) is highly prevalent in patients undergoing total joint arthroplasty (TJA) and is a major risk factor for postoperative cardiovascular complications and death. Recognizing this, the American Society of Anesthesiologists urges clinicians to implement special considerations in the perioperative care of OSA patients. However, as the volume of patients presenting for TJA increases, resources to implement these recommendations are limited. This necessitates mechanisms to efficiently risk stratify patients having OSA who may be susceptible to post-TJA cardiovascular complications. We explore the role of perioperative measurement of cardiac troponins (cTns) and brain natriuretic peptides (BNPs) in helping determine which OSA patients are at increased risk for post-TJA cardiovascular-related morbidity.
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Affiliation(s)
- M Melanie Lyons
- Division of Sleep Medicine, Center for Sleep & Circadian Neurobiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Department of Biobehavioral Research, School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
| | - Nitin Y Bhatt
- Division of Pulmonary, Allergy, Critical Care & Sleep Medicine, The Ohio State University, Columbus, OH, USA
| | - Elizabeth Kneeland-Szanto
- Division of Sleep Medicine, Center for Sleep & Circadian Neurobiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Brendan T Keenan
- Division of Sleep Medicine, Center for Sleep & Circadian Neurobiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Joanne Pechar
- Department of Penn Orthopaedics, Pennsylvania Hospital, University of Pennsylvania Health System, Philadelphia, PA, USA
| | - Branden Stearns
- Division of Sleep Medicine, Center for Sleep & Circadian Neurobiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Nabil M Elkassabany
- Department of Anesthesiology & Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Stavros G Memtsoudis
- Department of Anesthesiology & Public Health, Weill Cornell Medical College & Department of Anesthesiology, Hospital for Special Surgery, New York, NY, USA
| | - Allan I Pack
- Division of Sleep Medicine, Center for Sleep & Circadian Neurobiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Indira Gurubhagavatula
- Division of Sleep Medicine, Center for Sleep & Circadian Neurobiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Division of Sleep Medicine, CMC VA Medical Center, Philadelphia, PA, USA
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Patelis N, Kouvelos GN, Koutsoumpelis A, Moris D, Matsagkas MI, Arnaoutoglou E. An update on predictive biomarkers for major adverse cardiovascular events in patients undergoing vascular surgery. J Clin Anesth 2016; 33:105-16. [PMID: 27555142 DOI: 10.1016/j.jclinane.2016.03.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Revised: 09/27/2015] [Accepted: 03/05/2016] [Indexed: 10/21/2022]
Abstract
Cardiovascular complications signify a major cause of morbidity and mortality in patients undergoing vascular surgery adversely affecting both short- and long-term prognosis. During the last decade, unmet needs for a distinct cardiovascular risk assessment have led to an intensive research for establishment of biomarkers with sufficient predictive value. This literature review aims in examining the value of several biomarkers in predicting the incidence of major adverse cardiac events in vascular surgery patients. We reviewed the English language literature and analyzed the biomarkers as independent predictors or in correlation with other factors. We found several biomarkers showing a significant predictive value for a major adverse cardiovascular event in patients undergoing vascular surgery. These biomarkers can be used in clinical practice as outcome predictors, although sensitivity and specificity varies. Detection of subclinical cardiovascular damage may improve total risk estimation and facilitate clinical assessment of patients at risk for future cardiovascular events. The wide variety of sensitivity and specificity in predicting a MACE of these biomarkers exert the need for future trials in which these markers will be tested as adjunctive tools of cardiovascular risk estimation scoring systems.
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Affiliation(s)
- Nikolaos Patelis
- First Department of Surgery, Vascular Surgery Division, National & Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece.
| | - George N Kouvelos
- Department of Surgery, Vascular Surgery Unit, Medical School, University of Ioannina, Ioannina, Greece
| | - Andreas Koutsoumpelis
- First Department of Surgery, Vascular Surgery Division, National & Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | - Demetrios Moris
- First Department of Surgery, National & Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | - Miltiadis I Matsagkas
- Department of Surgery, Vascular Surgery Unit, Medical School, University of Ioannina, Ioannina, Greece
| | - Eleni Arnaoutoglou
- Department of Anesthesiology, Medical School, University of Ioannina, Ioannina, Greece
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Vanniyasingam T, Rodseth RN, Lurati Buse GA, Bolliger D, Burkhart CS, Cuthbertson BH, Gibson SC, Mahla E, Leibowitz DW, Biccard BM, Thabane L. Predicting the occurrence of major adverse cardiac events within 30 days of a vascular surgery: an empirical comparison of the minimum p value method and ROC curve approach using individual patient data meta-analysis. SPRINGERPLUS 2016; 5:304. [PMID: 27066338 PMCID: PMC4783313 DOI: 10.1186/s40064-016-1936-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Accepted: 02/25/2016] [Indexed: 12/16/2022]
Abstract
We aimed to compare the minimum p value method and the area under the receiver operating characteristics (ROC) curve approach to categorize continuous biomarkers for the prediction of postoperative 30-day major adverse cardiac events in noncardiac vascular surgery patients. Individual-patient data from six cohorts reporting B-type natriuretic peptide (BNP) or N-terminal pro-B-type natriuretic peptide (NTproBNP) were obtained. These biomarkers were dichotomized using the minimum p value method and compared with previously reported ROC curve-derived thresholds using logistic regression analysis. A final prediction model was developed, internally validated, and assessed for its sensitivity to clustering effects. Finally, a preoperative risk score system was proposed. Thresholds identified by the minimum p value method and ROC curve approach were 115.57 pg/ml (p < 0.001) and 116 pg/ml for BNP, and 241.7 pg/ml (p = 0.001) and 277.5 pg/ml for NTproBNP, respectively. The minimum p value thresholds were slightly stronger predictors based on our logistic regression analysis. The final model included a composite predictor of the minimum p value method’s BNP and NTproBNP thresholds [odds ratio (OR) = 8.5, p < 0.001], surgery type (OR = 2.5, p = 0.002), and diabetes (OR = 2.1, p = 0.015). Preoperative risks using the scoring system ranged from 2 to 49 %. The minimum p value method and ROC curve approach identify similar optimal thresholds. We propose to replace the revised cardiac risk index with our risk score system for individual-specific preoperative risk stratification after noncardiac nonvascular surgery.
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Affiliation(s)
- Thuva Vanniyasingam
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Health Sciences Centre, Room 2C7, 1280 Main Street West, Hamilton, ON L8S 4K1 Canada
| | - Reitze N Rodseth
- Perioperative Research Unit, Department of Anaesthetics, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Pietermaritzburg, South Africa ; Department of Anaesthetics, Grey's Hospital, Pietermaritzburg, South Africa
| | - Giovanna A Lurati Buse
- Department of Anaesthesia, Surgical Intensive Care, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel, Basel, Switzerland
| | - Daniel Bolliger
- Department of Anaesthesia, Surgical Intensive Care, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel, Basel, Switzerland
| | | | - Brian H Cuthbertson
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre and University of Toronto, Toronto, ON Canada
| | | | - Elisabeth Mahla
- Department of Anesthesiology and Intensive Care Medicine, Medical University of Graz, Graz, Austria
| | - David W Leibowitz
- Division of Cardiology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Bruce M Biccard
- Department of Anaesthesia and Perioperative Medicine, University of Cape Town, Cape Town, South Africa
| | - Lehana Thabane
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Health Sciences Centre, Room 2C7, 1280 Main Street West, Hamilton, ON L8S 4K1 Canada ; Population Health Research Institute, Hamilton Health Sciences, Hamilton, ON Canada ; Biostatistics Unit, St Joseph's Healthcare, Hamilton, ON Canada ; Departments of Paediatrics and Anaesthesia, McMaster University, Hamilton, ON Canada ; Centre for Evaluation of Medicine, St Joseph's Healthcare, Hamilton, ON Canada
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8
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Barisione C, Garibaldi S, Brunelli C, Balbi M, Spallarossa P, Canepa M, Ameri P, Viazzi F, Verzola D, Lorenzoni A, Baldassini R, Palombo D, Pane B, Spinella G, Ghigliotti G. Prevalent cardiac, renal and cardiorenal damage in patients with advanced abdominal aortic aneurysms. Intern Emerg Med 2016; 11:205-12. [PMID: 26510876 DOI: 10.1007/s11739-015-1328-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 09/29/2015] [Indexed: 11/25/2022]
Abstract
Chronic kidney disease (CKD), cardiac damage (CD) and the combination of the two are associated with increased morbidity and death in patients admitted to vascular surgery units. We assessed the prevalence of cardiac and renal damage and cardiorenal syndrome (CRS) in 563 patients with abdominal aortic aneurysms (AAA) who underwent cardiac screening before either an endovascular procedure (EVAR) or open surgery (OS) for aneurysm repair. CD was defined by ≥stage B as per the ACC/AHA classification of congestive heart failure (CHF), while CKD was defined by estimated GFR <60 mL/min/1.73 m(2) (CKD-EPI). Anemia [World Health Organization (WHO) guidelines] and iron deficiency (ID) (criteria for CHF patients) were also calculated. AAA patients were stratified into the following groups: CD, CKD, CRS or none of these conditions [no risk factors (NoRF)]. The prevalence of isolated cardiac and renal structural damage, of combined cardiorenal damage and of ID was 24.1, 15.0, 20.6 and 23.4 %, respectively. The frequency of anemia (mostly unrecognized) among the groups increased from NoRF (12.8 %)/CKD (19 %)/CD (25 %) up to CRS (38.8 %). This large-scale observational study provides clues for the increased CD/CKD risk profiles of unselected AAA patients, and underlines the need for better identification of ID/anemia and for appropriate treatment of CKD and CD before these patients undergo EVAR/OS.
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Affiliation(s)
- Chiara Barisione
- Division of Cardiology, IRCCS San Martino University Hospital-IST, Research Center of Cardiovascular Biology, University of Genova, Viale Benedetto XV, 6., 16132, Genova, Italy
| | - Silvano Garibaldi
- Division of Cardiology, IRCCS San Martino University Hospital-IST, Research Center of Cardiovascular Biology, University of Genova, Viale Benedetto XV, 6., 16132, Genova, Italy
| | - Claudio Brunelli
- Division of Cardiology, IRCCS San Martino University Hospital-IST, Research Center of Cardiovascular Biology, University of Genova, Viale Benedetto XV, 6., 16132, Genova, Italy
| | - Manrico Balbi
- Division of Cardiology, IRCCS San Martino University Hospital-IST, Research Center of Cardiovascular Biology, University of Genova, Viale Benedetto XV, 6., 16132, Genova, Italy
| | - Paolo Spallarossa
- Division of Cardiology, IRCCS San Martino University Hospital-IST, Research Center of Cardiovascular Biology, University of Genova, Viale Benedetto XV, 6., 16132, Genova, Italy
| | - Marco Canepa
- Division of Cardiology, IRCCS San Martino University Hospital-IST, Research Center of Cardiovascular Biology, University of Genova, Viale Benedetto XV, 6., 16132, Genova, Italy
| | - Pietro Ameri
- Division of Cardiology, IRCCS San Martino University Hospital-IST, Research Center of Cardiovascular Biology, University of Genova, Viale Benedetto XV, 6., 16132, Genova, Italy
| | - Francesca Viazzi
- Department of Nephrology, IRCCS San Martino University Hospital-IST, University of Genova, Genova, Italy
| | - Daniela Verzola
- Department of Nephrology, IRCCS San Martino University Hospital-IST, University of Genova, Genova, Italy
| | - Alessandra Lorenzoni
- Division of Cardiology, IRCCS San Martino University Hospital-IST, Research Center of Cardiovascular Biology, University of Genova, Viale Benedetto XV, 6., 16132, Genova, Italy
| | - Riccardo Baldassini
- Division of Cardiology, IRCCS San Martino University Hospital-IST, Research Center of Cardiovascular Biology, University of Genova, Viale Benedetto XV, 6., 16132, Genova, Italy
| | - Domenico Palombo
- Division of Cardiology, IRCCS San Martino University Hospital-IST, Research Center of Cardiovascular Biology, University of Genova, Viale Benedetto XV, 6., 16132, Genova, Italy
| | - Bianca Pane
- Division of Cardiology, IRCCS San Martino University Hospital-IST, Research Center of Cardiovascular Biology, University of Genova, Viale Benedetto XV, 6., 16132, Genova, Italy
| | - Giovanni Spinella
- Division of Cardiology, IRCCS San Martino University Hospital-IST, Research Center of Cardiovascular Biology, University of Genova, Viale Benedetto XV, 6., 16132, Genova, Italy
| | - Giorgio Ghigliotti
- Division of Cardiology, IRCCS San Martino University Hospital-IST, Research Center of Cardiovascular Biology, University of Genova, Viale Benedetto XV, 6., 16132, Genova, Italy.
- Unit of Vascular and Endovascular Surgery, University of Genova, Genova, Italy.
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9
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Rodseth RN, Vasconcellos K, Naidoo P, Biccard BM. Preoperative B-type natriuretic peptide risk stratification: do postoperative indices add value? SOUTHERN AFRICAN JOURNAL OF ANAESTHESIA AND ANALGESIA 2014. [DOI: 10.1080/22201173.2013.10872893] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- RN Rodseth
- Perioperative Research Group, Department of Anaesthetics, University of KwaZulu-Natal, Durban; Outcomes Research Consortium, Cleveland, Ohio
| | - K Vasconcellos
- Outcomes Research Consortium, Cleveland, Ohio; Department of Anaesthetics and Critical Care, King Edward V Hospital, Durban
| | - P Naidoo
- National Health Laboratory Services; Department of Chemical Pathology, Nelson R Mandela School of Medicine, University of KwaZulu-Natal
| | - BM Biccard
- Perioperative Research Group, Department of Anaesthetics, University of KwaZulu-Natal, Durban
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Biccard BM, Devereaux PJ, Rodseth RN. Cardiac biomarkers in the prediction of risk in the non-cardiac surgery setting. Anaesthesia 2014; 69:484-93. [PMID: 24738805 DOI: 10.1111/anae.12635] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2014] [Indexed: 12/24/2022]
Abstract
B-Type natriuretic peptides and troponin measurements have potential in predicting risk in patients undergoing non-cardiac surgery. Using the American Heart Association framework for the evaluation of novel biomarkers, we review the current evidence supporting the peri-operative use of these two biomarkers. In patients having major non-cardiac surgery who are risk stratified using clinical risk scores, the measurement of natriuretic peptides and troponin, both before and after surgery, significantly improves risk stratification. However, only pre- and postoperative natriuretic peptide measurement and postoperative troponin measurement have shown clinical utility. It is now important for trials to be conducted to determine whether integrating pre- and postoperative natriuretic peptide and postoperative troponin measurement into clinical practice is able to improve clinical outcomes in patients undergoing non-cardiac surgery.
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Affiliation(s)
- B M Biccard
- Perioperative Research Group, Department of Anaesthetics, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
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11
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Klein AA, Pozniak A, Pandit JJ. Salami slicing or living off the fat? Justifying multiple publications from a single HIV dataset. Anaesthesia 2014; 69:195-8. [DOI: 10.1111/anae.12603] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- A. A. Klein
- Department of Anaesthesia and Intensive Care Papworth Hospital; Cambridge UK
| | - A. Pozniak
- Chelsea and Westminster NHS Foundation Trust; London UK
| | - J. J. Pandit
- Nuffield Department of Anaesthetics; Oxford University Hospitals; Oxford UK
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12
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13
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Biccard BM, Naidoo P, de Vasconcellos K. What is the best pre-operative risk stratification tool for major adverse cardiac events following elective vascular surgery? A prospective observational cohort study evaluating pre-operative myocardial ischaemia monitoring and biomarker analysis. Anaesthesia 2012; 67:389-95. [DOI: 10.1111/j.1365-2044.2011.07020.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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14
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Biccard BM, Lurati Buse GA, Burkhart C, Cuthbertson BH, Filipovic M, Gibson SC, Mahla E, Leibowitz DW, Rodseth RN. The influence of clinical risk factors on pre-operative B-type natriuretic peptide risk stratification of vascular surgical patients. Anaesthesia 2011; 67:55-59. [DOI: 10.1111/j.1365-2044.2011.06958.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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15
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Biccard B, Rodseth R. Utility of clinical risk predictors for preoperative cardiovascular risk prediction. Br J Anaesth 2011; 107:133-43. [DOI: 10.1093/bja/aer194] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
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Rodseth RN, Lurati Buse GA, Bolliger D, Burkhart CS, Cuthbertson BH, Gibson SC, Mahla E, Leibowitz DW, Biccard BM. The Predictive Ability of Pre-Operative B-Type Natriuretic Peptide in Vascular Patients for Major Adverse Cardiac Events. J Am Coll Cardiol 2011; 58:522-9. [DOI: 10.1016/j.jacc.2011.04.018] [Citation(s) in RCA: 87] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2011] [Revised: 02/22/2011] [Accepted: 04/12/2011] [Indexed: 10/17/2022]
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17
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Redfern G, Rodseth RN, Biccard BM. Outcomes in vascular surgical patients with isolated postoperative troponin leak: a meta-analysis. Anaesthesia 2011; 66:604-10. [DOI: 10.1111/j.1365-2044.2011.06763.x] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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