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Cardiac Biomarkers and Prediction of Early Outcome After Heart Valve Surgery: A Prospective Observational Study
Aaron Wozolek1, Oceane Jaquet1, Anne-Françoise Donneau2
1Department of Anesthesia and Intensive Care Medicine, CHU of Liège, Liège, Belgium.
Insights
Cardiac biomarkers did not predict short-term outcomes in valve surgery patients. However, Galectin-3 and sST2 showed potential for improving long-term survival prediction, warranting further investigation.
Area of Science:
- Cardiology
- Biomarker Research
- Surgical Outcomes
Background:
- Circulating cardiac biomarkers are recognized for predicting long-term outcomes post-cardiac surgery.
- The utility of these biomarkers in predicting short-term morbidity remains less understood.
Purpose of the Study:
- To evaluate the predictive value of specific cardiac biomarkers for short-term outcomes after aortic or mitral valve surgery.
- To assess if these biomarkers enhance the prediction of short-term and long-term postoperative complications.
Main Methods:
- A prospective observational study involving 250 patients undergoing valve surgery.
- Preoperative plasma concentrations of sST2, Galectin-3, GDF-15, and NT-proBNP were analyzed.
- Logistic regression and Cox proportional hazards models were used to assess associations with outcomes.
Main Results:
- No significant association was found between the four biomarkers and the primary composite outcome of 30-day mortality, prolonged inotropic support, or extended ICU stay.
- Preoperative Galectin-3 and sST2 levels were significantly associated with one-year survival.
- Galectin-3 also correlated with postoperative acute kidney injury and improved prediction models for both one-year mortality and acute kidney injury when combined with EuroSCORE II.
Conclusions:
- Cardiac biomarkers appear to have limited utility in predicting short-term outcomes after cardiac surgery.
- These biomarkers may hold potential for refining the prediction of long-term outcomes, particularly survival and specific complications like acute kidney injury.
- Positive findings were primarily on secondary outcomes and should be interpreted with caution.
Objectives:
Circulating cardiac biomarkers may improve the prediction of long-term outcomes after cardiac surgery. The authors sought to assess if cardiac biomarkers also help better predict short-term morbidity.
Design:
Prospective observational study.
Setting:
Single academic hospital.
Participants:
A total of 250 patients undergoing aortic or mitral valve surgery with or without associated coronary artery bypass grafts.
Intervention:
None MEASUREMENT AND MAIN RESULTS: Relationships between preoperative plasma concentrations of four cardiac biomarkers (sST2, Galectin-3, GDF-15, and NT-proBNP) and postoperative outcome were assessed using logistic regressions and Cox proportional hazards models. The primary outcome was a composite of 30-day mortality, an inotropic support longer than 48 hours and an initial length of stay in the intensive care >five days. Secondary outcome measures were postoperative acute kidney injury, inotropic support duration, lengths of intensive care unit and hospital stays, and 30-day and one-year mortality. No association was observed between any of the four cardiac biomarkers and the primary outcome. The preoperative levels of Galectin-3 (hazard ratio = 1.2; p < 0.001) and sST2 (hazard ratio = 1.01, p < 0.001) were significantly associated with one-year survival, and their addition to the EuroSCORE II significantly improved the prediction of one-year mortality (p < 0.001). Similarly, Galectin-3 was associated with postoperative acute kidney injury (odds ratio = 1.15, p = 0.001) and improved the prediction of this complication when added to the EuroSCORE II (p = 0.002).
Conclusions:
These results suggested that the ability of cardiac biomarkers to predict short-term outcome after cardiac surgery, though of interest, appears limited. Conversely, cardiac biomarkers may have the potential to refine the prediction of long-term outcome. Admittedly, all positive results were obtained on secondary outcomes and must be regarded with caution.
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