Document Detail

Evaluation of cardiac involvement following major orthopedic surgery.
MedLine Citation:
PMID:  17087646     Owner:  NLM     Status:  MEDLINE    
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.
Martina Montagnana; Giuseppe Lippi; Dario Regis; Cristiano Fava; Gino Viola; Pietro Bartolozzi; Gian Cesare Guidi
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Clinical chemistry and laboratory medicine : CCLM / FESCC     Volume:  44     ISSN:  1434-6621     ISO Abbreviation:  Clin. Chem. Lab. Med.     Publication Date:  2006  
Date Detail:
Created Date:  2006-11-07     Completed Date:  2007-01-17     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9806306     Medline TA:  Clin Chem Lab Med     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  1340-6     Citation Subset:  IM    
Sezione di Chimica e Microscopia Clinica, Dipartimento di Scienze Morfologico-Biomediche, Università degli Studi di Verona, Verona, Italy.
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MeSH Terms
Aged, 80 and over
Arthroplasty / adverse effects
Biological Markers / blood
Creatine Kinase, MB Form / blood
Heart Diseases / blood,  diagnosis,  etiology*
Hip / surgery
Infusions, Intravenous / adverse effects
Knee / surgery
Middle Aged
Myoglobin / blood
Natriuretic Peptide, Brain / blood
Orthopedic Procedures / adverse effects*,  methods
Peptide Fragments / blood
Predictive Value of Tests
Serum Albumin / analysis,  metabolism
Spine / surgery
Troponin T / blood
Reg. No./Substance:
0/Biological Markers; 0/Myoglobin; 0/Peptide Fragments; 0/Serum Albumin; 0/Troponin T; 0/pro-brain natriuretic peptide (1-76); 114471-18-0/Natriuretic Peptide, Brain; EC Kinase, MB Form

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