Issn Print: 0265-0215

Publication Date: 2006/06/01


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Use of N-terminal pro-Brain Natriuretic peptide in pre-operative assessment: A-201

B. Messer; C. Parker; C. Snowden; G. Handley; F. McAuley

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Author Information: Department of Anaesthesia, Freeman Hospital, Newcastle; 2Department of Gastroenterology, James Cook University Hospital, Middlesborough; 3Queen Elizabeth Hospital

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Background and Goal of Study: B-Type Natriuretic peptide (BNP) is released by ventricular myocytes in response to stretch. Its prohormone, pro-BNP is used to diagnose and monitor heart failure. Pro-BNP levels of <35pmol/l have excellent negative predictive value (NPV) for cardiac impairment. Resting echocardiography (Echo) is often used during preoperative assessment to rule out cardiac dysfunction. We investigated the use of pro-BNP in this context and examined its role in reducing the requirement for pre-operative Echo.
Materials and Methods: Patients attending anaesthetic preassessment clinic and who were due to undergo echocardiography were studied. All patients had a pro-BNP added to their preoperative bloods. A questionnaire including history of Myocardial Infarction (MI) and functional status was completed. Reported abnormalities in Echo findings included regional wall motion defects, overall contractility and valve lesions.
Results and Discussions: All 58 patients had a pro-BNP taken, 57 (98%) presented for echocardiogram and 47 (81%) answered the cardiac questionnaire.
Conclusions: The use of pro-BNP coupled with a negative history of MI in our study, correctly identified all patients with a normal Echo (sensitivity 100%), eliminating the need for a more expensive and invasive test. This significantly improved on either clinical history or pro-BNP levels alone. This data suggests that a protocol based on clinical history and pro-BNP levels may correctly identify patients presenting for preoperative assessment who do not need an echocardiogram, reducing further preoperative cardiovascular investigation.
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