The role of baseline N-terminal B-type natriuretic peptide in the early postoperative period in patients with infective endocarditis

Abstract

In press

Biomarkers indicating various pathophysiological stages of Acute Heart Failure (AHF) remain crucial as a powerful tool for diagnosing and stratifying high-risk patients susceptible to heart failure progression. Although early cardiac surgical intervention is a primary treatment approach for AHF in Infective Endocarditis (IE), hospital mortality rates remain high. This single-center retrospective cohort study included clinical data of patients with active IE who underwent cardiac surgery at the Amosov National Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine from 2019 to 2021. The diagnosis of IE was established according to the Duke criteria. All patients underwent surgery under moderate hypothermia (30°C) with the use of a crystalloid cardioplegic solution. Data on preoperative heart function, serum creatinine, hemoglobin, procalcitonin, troponin, and NT-pro-BNP were collected. Patients were grouped according to the degree of preoperative heart failure based on the New York Heart Association Functional Classification, and NT-proBNP cutoff values were determined for each group. Predictors of AHF were analyzed, and clinical outcomes in patients with IE were assessed and compared. In the early postoperative period, the duration of dobutamine and norepinephrine therapy, mechanical ventilation, and length of stay in the Intensive Care Unit (ICU) were evaluated. Patients with higher NT-pro-BNP levels exhibited signs of acute heart failure (end-diastolic index (p<0.05), end-systolic index (p<0.001)) and were characterized by acute kidney injury (serum creatinine (p<0.01)) and anemia (erythrocytes (p<0.01)). No statistical difference in procalcitonin and troponin levels was observed between the groups. A significant positive correlation was found between baseline NT-proBNP level and the duration of dobutamine infusion (r²=0.156; p<0.001), norepinephrine infusion (r²=0.224; p=0.019), mechanical ventilation (r²=0.073; p=0.006), and ICU stay (r²=0.086; p=0.004).

Keywords: heart failure markers, troponin, procalcitonin, cardiac surgery, sepsis.