BNP for Predicting Postoperative Adverse Cardiovascular Events of Non-Cardiac Surgery: A Meta-Analysis_Chinese Journal of Evidence-Based Medicine

Authors：

ZHANG Bei ,  WANG Jiang , YE Jianrong

Department of Anesthesia, The First Hospital Affiliated to Xinjiang Medical University, Urumqi 830054, China;

Corresponding author：

WANG Jiang, Email: 710985359@qq.com

Keywords：

Brain natriuretic peptide (BNP); N-terminal pro-brain natriuretic peptide (NT-proBNP); Non-cardiac surgery; Adverse cardiovascular event; Meta-analysis; Systematic review; Cohort study

DOI：

10.7507/1672-2531.20120226

Video：

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Objective 　To systematically evaluate the effectiveness and accuracy of brain natriuretic peptide (BNP) for predicting postoperative cardiovascular events of non-cardiac surgery.
Methods 　Databases including The Cochrane Library, PubMed, Ovid, EMbase, WanFang Data and CNKI were searched electrically to collect literature published from 2000 to 2011, and relevant periodicals and references of the included studies were also manually retrieved. According to the inclusion and exclusion criteria, related cohort studies were selected, data were extracted, and quality of the included studies was evaluated by two reviewers independently. Then meta-analysis was conducted using RevMan 5.0 software.
Results 　A total of 11 studies involving 3 649 patients were included. The results of meta-analysis showed that, compared with patients with lower BNP levels than the cut-off point before surgery, patients with higher BNP levels than the cut-off point before surgery suffered from a higher incidence of cardiovascular events, with a significant difference (OR=27.54, 95%CI 17.49 to 43.35, P lt;0.000 01), while the result of N-terminal pro-brain natriuretic peptide (NT-proBNP) was similar to that of BNP (OR=19.53, 95%CI 13.54 to 28.17, P lt;0.000 01).
Conclusion 　Postoperative higher levels of BNP and NT-BNP can be used to predict postoperative cardiovascular events of non-cardiac surgery patients. This conclusion needs to be further proved by more high quality studies due to the quality limitation of the included studies.

Citation： ZHANG Bei,WANG Jiang,YE Jianrong. BNP for Predicting Postoperative Adverse Cardiovascular Events of Non-Cardiac Surgery: A Meta-Analysis. Chinese Journal of Evidence-Based Medicine, 2012, 12(12): 1463-1469. doi: 10.7507/1672-2531.20120226 Copy

1.	Devereaux PJ, Yang H, Yusuf S, et al. Effects of extended-release metoprolol succinate in patients undergoing non-cardiac surgery (POISE trial): A randomized controlled trial. Lancet, 2008, 371(9627): 1839-1847.
2.	Weidemann A, Klanke B, Wagner M, et al. Hypoxia, via stabilization of the hypoxia-inducible factor HIF-1alpha, is a direct and sufficient stimulus for brain-type natriuretic peptide induction. Biochem J, 2008, 409(1): 233-442.
3.	Alter P, Rupp H, Rominger MB, et al. B-type natriuretic peptide and wall stress in dilated human heart. Mol Cell Biochem, 2008, 314(1-2): 179-191.
4.	Weber M, Hamm C. Role of B-type natriuretic peptide (BNP) and NT-proBNP in clinical routine. Heart, 2006, 92(6): 843-849.
5.	Stroup DF, Brtlin JA, Morton SC, et al. Meta analysis of observational studies in epidemiology: a proposal for reporting. Meta analysis of observational studies in epidemiology (MOOSE) group. JAMA, 2000, 283(15): 2008-2012.
6.	Wells GA, Shea B, O’Connell D. Newcastle- Ottawascale. 2006, Available from: URL: http://www.ohri.ca/programs/clinical_epidemiology/oxford.htm.
7.	Van Zaane B, Nur E, Squizzato A, et al. Hypercoagulable State in Cushing’s Syndrome: A Systematic Review. J Clin Endocrinol Metab, 2009, 94(12): 2743-2750.
8.	Cuthbertson BH, Card G, Croal BL, et al. The utility of B-type natriuretic peptide in predicting postoperative cardiac events and mortality in patients undergoing major emergency non-cardiac surgery. Anaesthesia, 2007, 62(9): 875-881.
9.	Cuthbertson BH, Amiri AR, Croal BL, et al. Utility of B-type natriuretic peptide in predicting perioperative cardiac events in patients undergoing major non-cardiac surgery. Br J Anaesth, 2007, 99(2): 170-176.
10.	Berry C, Kingsmore D, Gibson S, et al. Predictive value of plasma brain natriuretic peptide for cardiac outcome after vascular surgery. Heart, 2006, 92(3): 401-402.
11.	Cardinale D, Colombo A, Sandri MT, et al. Increased perioperative N-terminal pro-B-type natriuretic peptide levels predict atrial fibrillation after thoracic surgery for lung cancer. Circulation, 2007, 115(11): 1339-1344.
12.	Leibowitz D, Planer D, Rott D, et al. Brain natriuretic peptide levels predict perioperative events in cardiac patients undergoing noncardiac surgery: A prospective study. Cardiology, 2007, 110 (4): 266-270.
13.	Goei D, Schouten O, Boersma E, et al. Influence of renal function on the usefulness of N-terminal pro-B-type natriuretic peptide as a prognostic cardiac risk marker in patients undergoing noncardiac vascular surgery. Am J Cardiol, 2008, 101 (1): 122-126.
14.	Feringa HH, Bax JJ, Elhendy A, et al. Association of plasma N-terminal pro-B-type natriuretic peptide with postoperative cardiac events in patients undergoing surgery for abdominal aortic aneurysm or leg bypass. Am J Cardiol, 2006, 98(1): 111-115.
15.	Feringa HH, Schouten O, Dunkelgrun M, et al. Plasma N-terminal pro-B-type natriuretic peptide as long-term prognostic marker after major vascular surgery. Heart, 2007, 93(2): 226-231.
16.	Dernellis J, Panaretou M. Assessment of cardiac risk before non-cardiac surgery: Brain natriuretic peptide in 1,590 patients. Heart, 2006, 92(11): 1645-1650.
17.	Yun KH, Jeong MH, Oh SK, et al. Preoperative plasma N-terminal pro-brain natriuretic peptide concentration and periop erative cardiovascular risk in elderly patients. Circ J, 2008, 72(2): 195-199.
18.	Gibson SC, Payne CJ, Byrne DS, et al. B-type natriuretic peptide predicts cardiac morbidity and mortality after major surgery. Br J Surg, 2007, 94(7): 903-909.
19.	Fleisher LA, Beckman JA, Brown KA, et al. ACC/AHA 2007 guidelines on perioperative cardiovascular evaluation and care for noncardiacsurgery: A report of the American College of Cardiology/American Heart AssociationTask Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery): developed in collaboration with the American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Rhythm Society, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions,Society for Vascular Medicine and Biology, and Society for Vascular Surgery. Circulation, 2007, 116(17): e418-499.
20.	黄青青, 岳锦熙, 万林骏, 等. 非心血管手术患者心脏危险性术前评估方法的比较. 中华麻醉学杂志, 2005, 25(10): 733-736.
21.	Goetze JP, Christoffersen C, Perko M, et al. Increased cardiac BNP expression associated with myocardial ischemia. FASEB J, 2003, 17(9): 1105-1107.
22.	Vanzetto G, Jacon P, Calizzano A, et al. N-terminal pro-brain natriuretic peptide predicts myocardial ischemia and is related to postischemic left-ventricular dysfunction in patients with stable coronary artery disease. J Nucl Cardiol, 2007, 14(6): 835-842.
23.	McDonagh TA, Robb SD, Murdoch DR, et al. Biochemical detection of left-ventricular systolic dysfunction. Lancet, 1998, 351(9095): 9 -13.
24.	Niizuma S, Iwanaga Y, Yahata T, et al. Plasma B-type natriuretic peptide levels reflect the presence and severity of stable coronary artery disease in chronic haemodialysis patients. Nephrol Dial Transplant, 2009, 24(2): 597- 603.
25.	肖军, 唐发宽, 华宁, 等. BNP与ACC/AHA指南评估老年非心脏手术心血管事件比较分析. 中国误诊学杂志, 2008, 8(11): 2521-2523.
26.	Gackowski A, Isnard R, Golmard JL, et al. Comparison of echocardiography and plasma B-type natriuretic peptide for monitoring the response to treatment in acute heart failure. Eur Heart J, 2004, 25(20): 1788-1796.
27.	Frangiskos I. Parthenakis, Alexandros P, et al. NT-proBNP response to dobutamine stress echocardiography predicts left ventricular contractile reserve in dilated cardiomyopathy. European Journal of Heart Failure, 2008, 10(5): 475-481.
28.	Galasko GI, Lahiri A, Barnes SC, et al, What is the normal range for N-terminal pro-brain natriuretic peptide? How well does this normal range screen for cardiovascular disease? Eur Heart J, 2005, 26(21): 2269-2276.
29.	Raymond I, Groenning BA, Hildebrandt PR, et al. The influence of age, sex and other variables on the plasma level of N-terminal pro brain natriuretic peptide in a large sample of the general population. Heart, 2003, 89(7): 745-751.
30.	Redfield MM, Rodeheffer RJ, Jacobsen SJ, et al. Plasma brain natriuretic peptide concentration: Impact of age and gender. J Am Coll Cardiol, 2002, 40(5): 976-982.
31.	沈洪兵. 循证医学. 见: 姜庆五, 主编. 临床流行病学. 第1版. 北京: 高等教育出版社, 2007: 240-250.

1. Devereaux PJ, Yang H, Yusuf S, et al. Effects of extended-release metoprolol succinate in patients undergoing non-cardiac surgery (POISE trial): A randomized controlled trial. Lancet, 2008, 371(9627): 1839-1847.
2. Weidemann A, Klanke B, Wagner M, et al. Hypoxia, via stabilization of the hypoxia-inducible factor HIF-1alpha, is a direct and sufficient stimulus for brain-type natriuretic peptide induction. Biochem J, 2008, 409(1): 233-442.
3. Alter P, Rupp H, Rominger MB, et al. B-type natriuretic peptide and wall stress in dilated human heart. Mol Cell Biochem, 2008, 314(1-2): 179-191.
4. Weber M, Hamm C. Role of B-type natriuretic peptide (BNP) and NT-proBNP in clinical routine. Heart, 2006, 92(6): 843-849.
5. Stroup DF, Brtlin JA, Morton SC, et al. Meta analysis of observational studies in epidemiology: a proposal for reporting. Meta analysis of observational studies in epidemiology (MOOSE) group. JAMA, 2000, 283(15): 2008-2012.
6. Wells GA, Shea B, O’Connell D. Newcastle- Ottawascale. 2006, Available from: URL: http://www.ohri.ca/programs/clinical_epidemiology/oxford.htm.
7. Van Zaane B, Nur E, Squizzato A, et al. Hypercoagulable State in Cushing’s Syndrome: A Systematic Review. J Clin Endocrinol Metab, 2009, 94(12): 2743-2750.
8. Cuthbertson BH, Card G, Croal BL, et al. The utility of B-type natriuretic peptide in predicting postoperative cardiac events and mortality in patients undergoing major emergency non-cardiac surgery. Anaesthesia, 2007, 62(9): 875-881.
9. Cuthbertson BH, Amiri AR, Croal BL, et al. Utility of B-type natriuretic peptide in predicting perioperative cardiac events in patients undergoing major non-cardiac surgery. Br J Anaesth, 2007, 99(2): 170-176.
10. Berry C, Kingsmore D, Gibson S, et al. Predictive value of plasma brain natriuretic peptide for cardiac outcome after vascular surgery. Heart, 2006, 92(3): 401-402.
11. Cardinale D, Colombo A, Sandri MT, et al. Increased perioperative N-terminal pro-B-type natriuretic peptide levels predict atrial fibrillation after thoracic surgery for lung cancer. Circulation, 2007, 115(11): 1339-1344.
12. Leibowitz D, Planer D, Rott D, et al. Brain natriuretic peptide levels predict perioperative events in cardiac patients undergoing noncardiac surgery: A prospective study. Cardiology, 2007, 110 (4): 266-270.
13. Goei D, Schouten O, Boersma E, et al. Influence of renal function on the usefulness of N-terminal pro-B-type natriuretic peptide as a prognostic cardiac risk marker in patients undergoing noncardiac vascular surgery. Am J Cardiol, 2008, 101 (1): 122-126.
14. Feringa HH, Bax JJ, Elhendy A, et al. Association of plasma N-terminal pro-B-type natriuretic peptide with postoperative cardiac events in patients undergoing surgery for abdominal aortic aneurysm or leg bypass. Am J Cardiol, 2006, 98(1): 111-115.
15. Feringa HH, Schouten O, Dunkelgrun M, et al. Plasma N-terminal pro-B-type natriuretic peptide as long-term prognostic marker after major vascular surgery. Heart, 2007, 93(2): 226-231.
16. Dernellis J, Panaretou M. Assessment of cardiac risk before non-cardiac surgery: Brain natriuretic peptide in 1,590 patients. Heart, 2006, 92(11): 1645-1650.
17. Yun KH, Jeong MH, Oh SK, et al. Preoperative plasma N-terminal pro-brain natriuretic peptide concentration and periop erative cardiovascular risk in elderly patients. Circ J, 2008, 72(2): 195-199.
18. Gibson SC, Payne CJ, Byrne DS, et al. B-type natriuretic peptide predicts cardiac morbidity and mortality after major surgery. Br J Surg, 2007, 94(7): 903-909.
19. Fleisher LA, Beckman JA, Brown KA, et al. ACC/AHA 2007 guidelines on perioperative cardiovascular evaluation and care for noncardiacsurgery: A report of the American College of Cardiology/American Heart AssociationTask Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery): developed in collaboration with the American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Rhythm Society, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions,Society for Vascular Medicine and Biology, and Society for Vascular Surgery. Circulation, 2007, 116(17): e418-499.
20. 黄青青, 岳锦熙, 万林骏, 等. 非心血管手术患者心脏危险性术前评估方法的比较. 中华麻醉学杂志, 2005, 25(10): 733-736.
21. Goetze JP, Christoffersen C, Perko M, et al. Increased cardiac BNP expression associated with myocardial ischemia. FASEB J, 2003, 17(9): 1105-1107.
22. Vanzetto G, Jacon P, Calizzano A, et al. N-terminal pro-brain natriuretic peptide predicts myocardial ischemia and is related to postischemic left-ventricular dysfunction in patients with stable coronary artery disease. J Nucl Cardiol, 2007, 14(6): 835-842.
23. McDonagh TA, Robb SD, Murdoch DR, et al. Biochemical detection of left-ventricular systolic dysfunction. Lancet, 1998, 351(9095): 9 -13.
24. Niizuma S, Iwanaga Y, Yahata T, et al. Plasma B-type natriuretic peptide levels reflect the presence and severity of stable coronary artery disease in chronic haemodialysis patients. Nephrol Dial Transplant, 2009, 24(2): 597- 603.
25. 肖军, 唐发宽, 华宁, 等. BNP与ACC/AHA指南评估老年非心脏手术心血管事件比较分析. 中国误诊学杂志, 2008, 8(11): 2521-2523.
26. Gackowski A, Isnard R, Golmard JL, et al. Comparison of echocardiography and plasma B-type natriuretic peptide for monitoring the response to treatment in acute heart failure. Eur Heart J, 2004, 25(20): 1788-1796.
27. Frangiskos I. Parthenakis, Alexandros P, et al. NT-proBNP response to dobutamine stress echocardiography predicts left ventricular contractile reserve in dilated cardiomyopathy. European Journal of Heart Failure, 2008, 10(5): 475-481.
28. Galasko GI, Lahiri A, Barnes SC, et al, What is the normal range for N-terminal pro-brain natriuretic peptide? How well does this normal range screen for cardiovascular disease? Eur Heart J, 2005, 26(21): 2269-2276.
29. Raymond I, Groenning BA, Hildebrandt PR, et al. The influence of age, sex and other variables on the plasma level of N-terminal pro brain natriuretic peptide in a large sample of the general population. Heart, 2003, 89(7): 745-751.
30. Redfield MM, Rodeheffer RJ, Jacobsen SJ, et al. Plasma brain natriuretic peptide concentration: Impact of age and gender. J Am Coll Cardiol, 2002, 40(5): 976-982.
31. 沈洪兵. 循证医学. 见: 姜庆五, 主编. 临床流行病学. 第1版. 北京: 高等教育出版社, 2007: 240-250.

Chinese Journal of Evidence-Based Medicine

BNP for Predicting Postoperative Adverse Cardiovascular Events of Non-Cardiac Surgery: A Meta-Analysis

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