Brain Natriuretic Peptide (BNP) in Patients Undergoing Coronary Artery Bypass Grafting

Abstract

Background: This study was designed to examine plasma concentrations of BNP and its relation to hemodynamic parameters in patients (pts.) with coronary artery disease (CAD) undergoing coronary artery bypass grafting (CABG). Methods: 21 pts. with CAD undergoing CABG were examined. The pts. were divided into two groups. Group I: normal left ventricular function (LVF); Group II: reduced LVF. Pre-, intra- and postoperative BNP and hemodynamic parameters were measured. The perioperative administration of inotropic drugs was documented. Results: In both groups postoperative BNP increased to a peak 24 h postoperatively; although BNP concentrations were high 24 h postoperatively hemodynamic parameters were improved in both groups. In Group I the BNP peak did not correlate with any hemodynamic parameter nor with the use of inotropic drugs. In Group II the BNP peak was inversely correlated with CO and CI and positively correlated with the PCWP. There was no correlation with inotropic support. Conclusion: Postoperative peak of BNP after 24 h does not reflect a state of acute perioperative heart failure or myocardial damage. These results suggest that the gene expression, metabolism and biological activity of BNP may be altered after extracorporeal circulation. Further studies are warranted to reveal the actual triggers for BNP increase early after CABG.

Key words

BNP - cardiac surgery - coronary artery bypass grafting - extracorporeal circulation

References

• 1 Nakao K, Mukoyama M, Hosoda K, Suga S, Ogawa Y, Saito Y, Shirakami G, Arai H, Jougasaki M, Imura H. Biosynthesis, secretion, and receptor selectivity of human brain natriuretic peptide.  Can J Physiol Pharmacol. 1991;  69 1500-1506
• 2 Richards A M, Nicholls M G, Yandle T G, Frampton C, Espiner E A, Turner J G, Buttimore R C, Lainchbury J G, Elliott J M, Ikram H, Crozier I G, Smyth D W. Plasma N-terminal pro-brain natriuretic peptide and adrenomedullin: new neurohormonal predictors of left ventricular function and prognosis after myocardial infarction.  Circulation. 1998;  97 1921-1929
• 3 Richards A M, Nicholls M G, Yandle T G, Ikram H, Espiner E A, Turner J G, Buttimore R C, Lainchbury J G, Elliott J M, Frampton C, Crozier I G, Smyth D W. Neuroendocrine prediction of left ventricular function and heart failure after acute myocardial infarction. The Christchurch Cardioendocrine Research Group.  Heart. 1999;  81 114-120
• 4 Clerico A, Iervasi G, Del Chicca M G, Emdin M, Maffei S, Nannipieri M, Sabatino L, Forini F, Manfredi C, Donato L. Circulating levels of cardiac natriuretic peptides (ANP and BNP) measured by highly sensitive and specific immunoradiometric assays in normal subjects and in patients with different degrees of heart failure.  J Endocrinol Invest. 1998;  21 170-179
• 5 Morimoto K, Mori T, Ishiguro S, Matsuda N, Hara Y, Kuroda H. Perioperative changes in plasma brain natriuretic peptide concentrations in patients undergoing cardiac surgery.  Surg Today. 1998;  28 23-29
• 6 Hata M, Masato O, Cho S, Narata M, Hata H, Inoue T, Sezai Y. [A correlation between atrial natriuretic peptide, brain natriuretic peptide, and perioperative cardiac and renal functions in open heart surgery].  Nippon Kyobu Geka Gakkai Zasshi. 1997;  45 1797-1802
• 7 Ationu A, Burch M, Elliott M, Carter N. Brain natriuretic peptide and fluid volume homeostasis - studies during cardiopulmonary bypass surgery.  Clin Auton Res. 1993;  3 275-280
• 8 Ationu A, Singer D R, Smith A, Elliott M, Burch M, Carter N D. Studies of cardiopulmonary bypass in children: implications for the regulation of brain natriuretic peptide.  Cardiovasc Res. 1993;  27 1538-1541
• 9 Hayabuchi Y, Matsuoka S, Kuroda Y. Plasma concentrations of atrial and brain natriuretic peptides and cyclic guanosine monophosphate in response to dobutamine infusion in patients with surgically repaired tetralogy of Fallot.  Pediatric Cardiology. 1999;  20 343-350
• 10 Luchner A, Burnett J C, Jougasaki M, Hense H W, Heid I M, Muders F, Riegger G J, Schunkert H. Evaluation of brain natriuretic peptide as marker of left ventricular dysfunction and hypertrophy in the population.  J Hypertens. 2000;  18 1121-1128
• 11 Hara Y, Hamada M, Shigematsu Y, Suzuki M, Kodama K, Kuwahara T, Hashida H, Ikeda S, Ohtsuka T, Hiasa G, Hiwada K. Effect of beta-blocker on left ventricular function and natriuretic peptides in patients with chronic heart failure treated with angiotensin-converting enzyme inhibitor.  JPN Circ J. 2000;  64 365-369
• 12 Mair P, Mair J, Bleier J, Hormann C, Balogh D, Puschendorf B. Augmented release of brain natriuretic peptide during reperfusion of the human heart after cardioplegic cardiac arrest.  Clin Chim Acta. 1997;  261 57-68
• 13 Lainchbury J G, Richards A M, Nicholls M G, Espiner E A, Yandle T G. Brain natriuretic peptide and neutral endopeptidase inhibition in left ventricular impairment.  J Clin Endocrinol Metab. 1999;  84 723-729
• 14 Pemberton C J, Johnson M L, Yandle T G, Espiner E A. Deconvolution analysis of cardiac natriuretic peptides during acute volume overload.  Hypertension. 2000;  36 355-359
• 15 Seghaye M-C, Duchateau J, Bruniaux J, Demontoux S, Détruit H, Bosson C, Lecronier G, Mokhfi E, Serraf A, Planché C. Endogenous nitric oxide production and atrial natriuretic peptide biological activity in infants undergoing cardiac operations.  J Crit Care. 1997;  25 1063-1067
• 16 Nakamura M, Arakawa N, Yoshida H, Makita S, Niinuma H, Hiramori K. Vasodilatory effects of B-type natriuretic peptide are impaired in patients with chronic heart failure.  Am Heart J. 1998;  135 414-420
• 17 Kenneth K Y, de Bold A J. Expression and secretion of BNP is selectively upregulated by pro-inflammatory cytokines. Poster session. The Endocrine Society's 85th annual Meeting. Philadelphia, USA, June 19 - 22. 2003: Abstract P2-589