Document Detail


B-type natriuretic peptide-guided therapy for perioperative medicine?
MedLine Citation:
PMID:  25332815     Owner:  NLM     Status:  PubMed-not-MEDLINE    
Abstract/OtherAbstract:
The recent guideline from the European Society of Cardiology and European Society of Anesthesiology recommended the use of B-type natriuretic peptide (BNP) as preoperative testing for high-risk cardiac patients undergoing non-cardiac surgery. In this article, the potential benefits, risks and details for implementing BNP testing in perioperative medicine are discussed. Review of four related lines of research including the use of BNP test for preoperative prognosis, BNP test for screening asymptomatic heart failure, BNP as prognostic test in asymptomatic, non-heart failure patients and using BNP for detecting silent myocardial ischaemia showed converging cut-off levels of BNP for risk stratification. BNP has better OR and relative risk in comparison with Revised Cardiac Risk Index (RCRI) in predicting perioperative cardiac risk. BNP-guided therapy can be low risk based on current evidence on non-surgical patients, including treating asymptomatic patients without heart failure to prevent cardiovascular complications. At present, there is lack of direct evidence supporting perioperative BNP testing. Further research with randomised controlled trials is needed to confirm the benefit of BNP-guided management. Preoperative BNP testing may be considered in patients with RCRI above 0 undergoing intermediate or high-risk surgery. BNP-guided therapy is likely a beneficial addition to perioperative medicine. Its combination with β-blocker titration, RCRI and perioperative cardiovascular monitoring can be a major advance in reducing cardiac risk resulting in a dynamic, individualised optimisation process.
Authors:
Charles Shang
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Publication Detail:
Type:  Journal Article     Date:  2014-08-05
Journal Detail:
Title:  Open heart     Volume:  1     ISSN:  2053-3624     ISO Abbreviation:  Open Heart     Publication Date:  2014  
Date Detail:
Created Date:  2014-10-21     Completed Date:  2014-10-21     Revised Date:  2014-10-23    
Medline Journal Info:
Nlm Unique ID:  101631219     Medline TA:  Open Heart     Country:  England    
Other Details:
Languages:  eng     Pagination:  e000105     Citation Subset:  -    
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