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Evaluation of cardiac involvement following major orthopedic surgery
Martina Montagnana1, Giuseppe Lippi, Dario Regis
1Sezione di Chimica e Microscopia Clinica, Dipartimento di Scienze Morfologico-Biomediche, Università degli Studi di Verona, Verona, Italy.
Insights
Major orthopedic surgery patients showed increased NT-proBNP, a cardiac stress marker, likely due to fluid infusion. Further research is needed for clinical significance, especially in heart failure patients.
Area of Science:
- Cardiology
- Anesthesiology
- Orthopedic Surgery
Background:
- Cardiovascular complications are common after non-cardiac surgery.
- Early detection of cardiac issues aids risk stratification.
- Orthopedic surgery patients are susceptible to perioperative cardiac events.
Purpose of the Study:
- To evaluate perioperative cardiac markers in major orthopedic surgery.
- To assess changes in NT-proBNP and IMA.
- To identify factors influencing cardiac marker elevation.
Main Methods:
- 37 patients undergoing major orthopedic surgery were studied.
- Cardiac markers NT-proBNP, IMA, cTnT, CK-MB, and myoglobin were measured.
- Measurements were taken preoperatively and at 4 and 72 hours postoperatively.
Main Results:
- NT-proBNP significantly increased at 72 hours post-surgery.
- IMA levels were elevated at 4 and 72 hours post-surgery.
- Perioperative fluid volume and creatinine changes correlated with NT-proBNP increase.
Conclusions:
- Major orthopedic surgery may induce subclinical cardiac stress, possibly from fluid administration.
- Elevated NT-proBNP warrants further investigation.
- Clinical significance in high-risk heart failure patients needs exploration.
Background:
Cardiovascular morbidity is frequent after non-cardiac surgery and the early recognition of cardiac involvement is an essential tool for clinical risk stratification and management. The aim of this study was to investigate the behavior of traditional and emerging cardiac markers, including NT-prohormone-brain natriuretic peptide (NT-proBNP) and ischemia-modified albumin (IMA), in the perioperative period in patients undergoing major uncomplicated orthopedic surgery.
Methods:
A total of 37 patients undergoing major orthopedic surgery were longitudinally evaluated for NT-proBNP, IMA, cardiac troponin T (cTnT), creatine kinase isoenzyme MB and myoglobin 3 h before surgery and 4 and 72 h thereafter.
Results:
NT-proBNP values were significantly increased at 72 h postoperative compared to both 3 h preoperative and 4 h postoperative (NT-proBNP: 20 vs. 4.5 pmol/L, p<0.001 and 20 vs. 5.9 pmol/L, p<0.001). IMA levels were significantly increased at 4 and 72 h postoperative vs. 3 h preoperative (132 vs. 113 kU/L, p=0.02 and 151 vs. 113 kU/L, p<0.001). In a stepwise regression model, the perioperative liquid amount and degree of modification in postoperative creatinine levels (delta-creatinine) were independently related to the NT-proBNP increase.
Conclusions:
The significant increase observed in NT-proBNP suggests that patients undergoing major uncomplicated orthopedic surgery may develop subclinical cardiac stress, presumably attributable to the considerable infusion of liquids. The clinical significance of this finding deserves further investigation, especially in patients at higher risk of heart failure.
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