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Plasma BNP Detects High Risk Patients with Asymptomatic Aortic Stenosis and Normal Left Ventricular Ejection Fraction
Abstracts
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515
Plasma BNP Detects High Risk Patients with Asymptomatic Aortic Stenosis and Normal Left Ventricular Ejection Fraction
Pre-operative Cardiovascular Risk Evaluation and Management Prior to Non-cardiac Surgery
L. Kearney 1,2,∗ ,
M. Ord 2 ,
K. Lu 2 ,
K. Profitis 2 ,
L. Burrell 1 ,
P. Srivastava 1,2
J. Mooney 1,∗ , M. McGarraghy 2 , R. Halliwell 3 , G. Hillis 1 , C. Chow 1,4 1 The
George Institute for Global Health, Sydney, Australia of Medicine and Dentistry, Aberdeen University, United Kingdom 3 Dept. of Anaesthesia, Westmead Hospital, Sydney, Australia 4 Dept. of Cardiology, Westmead Hospital, Sydney, Australia
1 Department
of Medicine, Austin Health, The University of Melbourne, Australia 2 Department of Cardiology, Austin Health, Melbourne, Australia
2 School
Background: Plasma BNP is an established prognostic marker in congestive cardiac failure, however its potential to identify high risk asymptomatic patients with aortic stenosis (AS) is not known. We examined the capacity of Plasma BNP to predict major adverse cardiac events (MACE) in patients with asymptomatic AS and normal left ventricular ejection fraction (LVEF > 50%). Method: Asymptomatic subjects with AS and normal LVEF were enrolled in the study (n = 71). Immediately after echocardiography, blood was taken for plasma BNP and renal function assessment. Baseline demographics and comorbidities were recorded. MACE, defined as death or hospitalisation due to cardiac causes, was identified from hospital record review. Results: The age (mean ± SD) of subjects was 75 ± 10 years and 64% were male. Baseline mean aortic valve gradient (mAVG) was 32 ± 18 mm Hg (range: 7–84 mm Hg) and LVEF 63 ± 7% (range: 50–79%). LVH was present in 47% of patients. Median plasma BNP was 107 pg/ml (IQR: 57–160 pg/ml). During a follow-up of 1.4 ± 0.3 years there were 30 MACE, including 18 patients requiring AVR (25%) and one death. An elevated plasma BNP (>100 pg/ml) was recorded in 38 subjects (53%) and was associated with a significant increase in the risk of MACE (Hazard ratio 3.2 (95%CI 1.3–7.6), p = 0.009). This finding was independent of age, gender, body mass index, mAVG, renal function and known IHD. Conclusions: Plasma BNP represents a promising marker for identification of high risk individuals with asymptomatic aortic stenosis and normal LV ejection fraction. Patients with severe AS and a plasma BNP >100 pg/ml may benefit from expedited AVR surgery.
Background: Cardiovascular (CV) events remain a significant cause of morbidity and mortality after non-cardiac surgery. We examined preoperative practice patterns with respect to CV risk evaluation and management. Methods: One hundred consecutive patients were recruited on random days over 16 weeks at a tertiary hospital in 2010. Patients were ≥45 years undergoing non-cardiac surgery. All patients had their Revised Cardiac Risk Index (RCRI) calculated and were interviewed regarding CV assessment in the previous 12 months. Results: Average age was 65 years (SD 10.9), 44% were female and 23% had coronary artery disease. Twentyone percent had diabetes mellitus (29% on insulin), 59% hypertension, and 53% hypercholesterolaemia. Seventeen percent were current smokers and 44% ex-smokers. Fortynine percent had RCRI score of 0, 36% a RCRI of 1 and 15% a RCRI of ≥2. Cardiac investigations were reported in 26% (8% RCRI = 0, 31% RCRI = 1 and 73% RCRI ≥2). Male patients were investigated more often than females (29% vs 23%), as were older patients (31% ≥65 years vs 21% <65 years). No patients were advised to take beta-blockers or statins. Of 17 current smokers, 10 (59%) recalled receiving pre-operative advice to quit. Thirty four patients were on anti-platelet agents, with nine advised to cease ≥7 days before surgery, 12 advised to cease between 5 and 7 days, four advised <5 days and nine advised to continue. Conclusion: There is substantial variation in CV investigation and risk management in patients undergoing surgery. Further research is required to understand whether differences in management influence perioperative outcomes. doi:10.1016/j.hlc.2011.05.519
doi:10.1016/j.hlc.2011.05.518
516 Pre-operative High-sensitive Troponin Concentration in Higher-risk Patients Undergoing Elective Non-cardiac Surgery R. Alcock ∗ , D. Kouzios, C. Naoum, G. Hillis, D. Brieger Concord Hospital, University of Sydney, Australia Background: Cardiac troponins are the most sensitive biochemical marker of myocardial injury, with newer high-sensitive troponin (hs-TnT) assays allowing the detection of lesser degrees of myocardial damage. HsTnT is elevated in approximately 10% of patients with
ABSTRACTS
Heart, Lung and Circulation 2011;20S:S156–S251
S211
514
515
Plasma BNP Detects High Risk Patients with Asymptomatic Aortic Stenosis and Normal Left Ventricular Ejection Fraction
Pre-operative Cardiovascular Risk Evaluation and Management Prior to Non-cardiac Surgery
L. Kearney 1,2,∗ ,
M. Ord 2 ,
K. Lu 2 ,
K. Profitis 2 ,
L. Burrell 1 ,
P. Srivastava 1,2
J. Mooney 1,∗ , M. McGarraghy 2 , R. Halliwell 3 , G. Hillis 1 , C. Chow 1,4 1 The
George Institute for Global Health, Sydney, Australia of Medicine and Dentistry, Aberdeen University, United Kingdom 3 Dept. of Anaesthesia, Westmead Hospital, Sydney, Australia 4 Dept. of Cardiology, Westmead Hospital, Sydney, Australia
1 Department
of Medicine, Austin Health, The University of Melbourne, Australia 2 Department of Cardiology, Austin Health, Melbourne, Australia
2 School
Background: Plasma BNP is an established prognostic marker in congestive cardiac failure, however its potential to identify high risk asymptomatic patients with aortic stenosis (AS) is not known. We examined the capacity of Plasma BNP to predict major adverse cardiac events (MACE) in patients with asymptomatic AS and normal left ventricular ejection fraction (LVEF > 50%). Method: Asymptomatic subjects with AS and normal LVEF were enrolled in the study (n = 71). Immediately after echocardiography, blood was taken for plasma BNP and renal function assessment. Baseline demographics and comorbidities were recorded. MACE, defined as death or hospitalisation due to cardiac causes, was identified from hospital record review. Results: The age (mean ± SD) of subjects was 75 ± 10 years and 64% were male. Baseline mean aortic valve gradient (mAVG) was 32 ± 18 mm Hg (range: 7–84 mm Hg) and LVEF 63 ± 7% (range: 50–79%). LVH was present in 47% of patients. Median plasma BNP was 107 pg/ml (IQR: 57–160 pg/ml). During a follow-up of 1.4 ± 0.3 years there were 30 MACE, including 18 patients requiring AVR (25%) and one death. An elevated plasma BNP (>100 pg/ml) was recorded in 38 subjects (53%) and was associated with a significant increase in the risk of MACE (Hazard ratio 3.2 (95%CI 1.3–7.6), p = 0.009). This finding was independent of age, gender, body mass index, mAVG, renal function and known IHD. Conclusions: Plasma BNP represents a promising marker for identification of high risk individuals with asymptomatic aortic stenosis and normal LV ejection fraction. Patients with severe AS and a plasma BNP >100 pg/ml may benefit from expedited AVR surgery.
Background: Cardiovascular (CV) events remain a significant cause of morbidity and mortality after non-cardiac surgery. We examined preoperative practice patterns with respect to CV risk evaluation and management. Methods: One hundred consecutive patients were recruited on random days over 16 weeks at a tertiary hospital in 2010. Patients were ≥45 years undergoing non-cardiac surgery. All patients had their Revised Cardiac Risk Index (RCRI) calculated and were interviewed regarding CV assessment in the previous 12 months. Results: Average age was 65 years (SD 10.9), 44% were female and 23% had coronary artery disease. Twentyone percent had diabetes mellitus (29% on insulin), 59% hypertension, and 53% hypercholesterolaemia. Seventeen percent were current smokers and 44% ex-smokers. Fortynine percent had RCRI score of 0, 36% a RCRI of 1 and 15% a RCRI of ≥2. Cardiac investigations were reported in 26% (8% RCRI = 0, 31% RCRI = 1 and 73% RCRI ≥2). Male patients were investigated more often than females (29% vs 23%), as were older patients (31% ≥65 years vs 21% <65 years). No patients were advised to take beta-blockers or statins. Of 17 current smokers, 10 (59%) recalled receiving pre-operative advice to quit. Thirty four patients were on anti-platelet agents, with nine advised to cease ≥7 days before surgery, 12 advised to cease between 5 and 7 days, four advised <5 days and nine advised to continue. Conclusion: There is substantial variation in CV investigation and risk management in patients undergoing surgery. Further research is required to understand whether differences in management influence perioperative outcomes. doi:10.1016/j.hlc.2011.05.519
doi:10.1016/j.hlc.2011.05.518
516 Pre-operative High-sensitive Troponin Concentration in Higher-risk Patients Undergoing Elective Non-cardiac Surgery R. Alcock ∗ , D. Kouzios, C. Naoum, G. Hillis, D. Brieger Concord Hospital, University of Sydney, Australia Background: Cardiac troponins are the most sensitive biochemical marker of myocardial injury, with newer high-sensitive troponin (hs-TnT) assays allowing the detection of lesser degrees of myocardial damage. HsTnT is elevated in approximately 10% of patients with
ABSTRACTS
Heart, Lung and Circulation 2011;20S:S156–S251