scholarly journals Preoperative B-type natriuretic peptides in patients undergoing noncardiac surgery: a cumulative meta-analysis

2015 ◽  
Vol 21 (4) ◽  
pp. 96-106
Author(s):  
Lisa Ryan ◽  
Chantal Rajah ◽  
Dale Simmers ◽  
Danielle Potgieter ◽  
Reitze N. Rodseth
Keyword(s):  
Natriuretic Peptides ◽  
Meta Analysis ◽  
Noncardiac Surgery

scholarly journals B-Type Natriuretic Peptides Help in Cardioembolic Stroke Diagnosis

Stroke ◽  
2015 ◽  
Vol 46 (5) ◽  
pp. 1187-1195 ◽  
Author(s):  
Víctor Llombart ◽  
Albert Antolin-Fontes ◽  
Alejandro Bustamante ◽  
Dolors Giralt ◽  
Natalia S. Rost ◽  
...  
Keyword(s):  
Natriuretic Peptides ◽  
Meta Analysis ◽  
Area Under The Curve ◽  
Cardioembolic Stroke ◽  
Blood Levels ◽  
Clinical Value ◽  
Predictive Values ◽  
Pubmed Database ◽  
Integrated Discrimination Improvement ◽  
Improvement Index

Background and Purpose— Determining the underlying cause of stroke is important to optimize secondary prevention treatment. Increased blood levels of natriuretic peptides (B-type natriuretic peptide/N-terminal pro-BNP [BNP/NT-proBNP]) have been repeatedly associated with cardioembolic stroke. Here, we evaluate their clinical value as pathogenic biomarkers for stroke through a literature systematic review and individual participants’ data meta-analysis. Methods— We searched publications in PubMed database until November 2013 that compared BNP and NT-proBNP circulating levels among stroke causes. Standardized individual participants’ data were collected to estimate predictive values of BNP/NT-proBNP for cardioembolic stroke. Dichotomized BNP/NT-proBNP levels were included in logistic regression models together with clinical variables to assess the sensitivity and specificity to identify cardioembolic strokes and the additional value of biomarkers using area under the curve and integrated discrimination improvement index. Results— From 23 selected articles, we collected information of 2834 patients with a defined cause. BNP/NT-proBNP levels were significantly elevated in cardioembolic stroke until 72 hours from symptoms onset. Predictive models showed a sensitivity >90% and specificity >80% when BNP/NT-proBNP were added considering the lowest and the highest quartile, respectively. Both peptides also increased significantly the area under the curve and integrated discrimination improvement index compared with clinical models. Sensitivity, specificity, and precision of the models were validated in 197 patients with initially undetermined stroke with final pathogenic diagnosis after ancillary follow-up. Conclusions— Natriuretic peptides are strongly increased in cardioembolic strokes. Future multicentre prospective studies comparing BNP and NT-proBNP might aid in finding the optimal biomarker, the best time point, and the optimal cutoff points for cardioembolic stroke identification.

scholarly journals Natriuretic peptides and troponins in pulmonary embolism: a meta-analysis

Thorax ◽  
2009 ◽  
Vol 64 (10) ◽  
pp. 869-875 ◽  
Author(s):  
J-C Lega ◽  
Y Lacasse ◽  
L Lakhal ◽  
S Provencher
Keyword(s):  
Pulmonary Embolism ◽  
Natriuretic Peptides ◽  
Meta Analysis

Preventing Postoperative Atrial Fibrillation After Noncardiac Surgery: A Meta-analysis

2018 ◽  
Vol 131 (7) ◽  
pp. 795-804.e5 ◽  
Author(s):  
Adam Oesterle ◽  
Benjamin Weber ◽  
Roderick Tung ◽  
Niteesh K. Choudhry ◽  
Jagmeet P. Singh ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Meta Analysis ◽  
Noncardiac Surgery ◽  
Postoperative Atrial Fibrillation

Opportunistic screening for heart failure with natriuretic peptides in patients with atrial fibrillation: a meta-analysis of individual participant data of four screening studies

Heart ◽  
2018 ◽  
Vol 104 (15) ◽  
pp. 1236.1-1237 ◽  
Author(s):  
Sander van Doorn ◽  
Geert-Jan Geersing ◽  
Rogier F Kievit ◽  
Yvonne van Mourik ◽  
Loes C Bertens ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Natriuretic Peptide ◽  
Natriuretic Peptides ◽  
Meta Analysis ◽  
Diagnostic Value ◽  
Community Dwelling ◽  
Individual Participant Data ◽  
Cut Point ◽  
Individual Participant

ObjectiveHeart failure (HF) often coexists in atrial fibrillation (AF) but is frequently unrecognised due to overlapping symptomatology. Furthermore, AF can cause elevated natriuretic peptide levels, impairing its diagnostic value for HF detection. We aimed to assess the prevalence of previously unknown HF in community-dwelling patients with AF, and to determine the diagnostic value of the amino-terminal pro B-type natriuretic peptide (NTproBNP) for HF screening in patients with AF.MethodsIndividual participant data from four HF-screening studies in older community-dwelling persons were combined. Presence or absence of HF was in each study established by an expert panel following the criteria of the European Society of Cardiology. We performed a two-stage patient-level meta-analysis to calculate traditional diagnostic indices.ResultsOf the 1941 individuals included in the four studies, 196 (10.1%) had AF at baseline. HF was uncovered in 83 (43%) of these 196 patients with AF, versus 381 (19.7%) in those without AF at baseline. Median NTproBNP levels of patients with AF with and without HF were 744 pg/mL and 211 pg/mL, respectively. At the cut-point of 125 pg/mL, sensitivity was 93%, specificity 35%, and positive and negative predictive values 51% and 86%, respectively. Only 23% of all patients with AF had an NTproBNP level below the 125 pg/mL cut-point, with still a 13% prevalence of HF in this group.ConclusionsWith a prevalence of nearly 50%, unrecognised HF is common among community-dwelling patients with AF. Given the high prior change, natriuretic peptides are diagnostically not helpful, and straightforward echocardiography seems to be the preferred strategy for HF screening in patients with AF.

scholarly journals Postoperative B-type Natriuretic Peptide for Prediction of Major Cardiac Events in Patients Undergoing Noncardiac Surgery

2013 ◽  
Vol 119 (2) ◽  
pp. 270-283 ◽  
Author(s):  
Reitze N. Rodseth ◽  
Bruce M. Biccard ◽  
Rong Chu ◽  
Giovana A. Lurati Buse ◽  
Lehana Thabane ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Cardiac Failure ◽  
Natriuretic Peptides ◽  
Primary Outcome ◽  
Area Under The Curve ◽  
Cardiovascular Complications ◽  
Noncardiac Surgery ◽  
Nonfatal Myocardial Infarction ◽  
Cardiac Mortality ◽  
Cardiac Events

Abstract Background: It is unclear whether postoperative B-type natriuretic peptides (i.e., BNP and N-terminal proBNP) can predict cardiovascular complications in noncardiac surgery. Methods: The authors undertook a systematic review and individual patient data meta-analysis to determine whether postoperative BNPs predict postoperative cardiovascular complications at 30 and 180 days or more. Results: The authors identified 18 eligible studies (n = 2,051). For the primary outcome of 30-day mortality or nonfatal myocardial infarction, BNP of 245 pg/ml had an area under the curve of 0.71 (95% CI, 0.64–0.78), and N-terminal proBNP of 718 pg/ml had an area under the curve of 0.80 (95% CI, 0.77–0.84). These thresholds independently predicted 30-day mortality or nonfatal myocardial infarction (adjusted odds ratio [AOR] 4.5; 95% CI, 2.74–7.4; P < 0.001), mortality (AOR, 4.2; 95% CI, 2.29–7.69; P < 0.001), cardiac mortality (AOR, 9.4; 95% CI, 0.32–254.34; P < 0.001), and cardiac failure (AOR, 18.5; 95% CI, 4.55–75.29; P < 0.001). For greater than or equal to 180-day outcomes, natriuretic peptides independently predicted mortality or nonfatal myocardial infarction (AOR, 3.3; 95% CI, 2.58–4.3; P < 0.001), mortality (AOR, 2.2; 95% CI, 1.67–86; P < 0.001), cardiac mortality (AOR, 2.1; 95% CI, 0.05–1,385.17; P < 0.001), and cardiac failure (AOR, 3.5; 95% CI, 1.0–9.34; P = 0.022). Patients with BNP values of 0–250, greater than 250–400, and greater than 400 pg/ml suffered the primary outcome at a rate of 6.6, 15.7, and 29.5%, respectively. Patients with N-terminal proBNP values of 0–300, greater than 300–900, and greater than 900 pg/ml suffered the primary outcome at a rate of 1.8, 8.7, and 27%, respectively. Conclusions: Increased postoperative BNPs are independently associated with adverse cardiac events after noncardiac surgery.

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