Preoperative Natriuretic Peptides in Noncardiac Surgery

Cardiac risk evaluation is a central component of most preoperative evaluation of adults undergoing noncardiac surgery. Many tools are available for preoperative cardiac assessment including cardiac risk scores, electrocardiogram, cardiac imaging, and cardiac stress tests. Biomarkers, and more specifically natriuretic peptides, have also been found to provide additional value for preoperative cardiac risk stratification and their routine use in at-risk patients have been recommended in recent perioperative guidelines. RÉSUMÉL'évaluation des risques cardiaques est un élément central de la plupart des évaluations préopératoires des adultes subissant une chirurgie non cardiaque. De nombreux outils sont disponibles pour l'évaluation cardiaque préopératoire, notamment les scores de risque cardiaque, l'électrocardiogramme, l'imagerie cardiaque et les tests d'effort cardiaque. On a également constaté que les biomarqueurs, et plus particulièrement les peptides natriurétiques, apportent une valeur supplémentaire pour la stratification du risque cardiaque préopératoire et leur utilisation systématique chez les patients à risque a été recommandée dans de récentes lignes directrices périopératoires

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Preoperative evaluation: biomarkers

ESC CardioMed ◽

10.1093/med/9780198784906.003.0634 ◽

2018 ◽

pp. 2642-2646

Author(s):

Emmanuelle Duceppe ◽

P. J. Devereaux

Keyword(s):

Cardiac Surgery ◽

Brain Natriuretic Peptide ◽

Risk Estimation ◽

Preoperative Evaluation ◽

Cardiac Risk ◽

Risk Scores ◽

Cardiac Events ◽

Clinical Risk ◽

Risk Biomarkers ◽

Robust Evidence

It is estimated that over 200 million major surgeries are performed worldwide annually, of which more than 10 million patients will suffer a major cardiac complication. Accurate preoperative cardiac risk estimation is important to allow patients to make informed decisions regarding surgery and to identify patients who require enhanced monitoring after surgery. Physicians primarily use clinical evaluation to assess preoperative cardiac risk, and often clinicians use clinical risk scores. Although such scores have utility, these clinical risk scores often underestimate perioperative cardiac risk. Biomarkers further enhance risk prediction; tests can be performed quickly with limited costs, with results readily available during initial preoperative evaluation. The predictive capabilities of several biomarkers have been studied in non-cardiac surgery. N-terminal pro-brain natriuretic peptide (NT-proBNP) and BNP have the most robust evidence supporting their use to enhance prediction of perioperative major cardiac events.

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Risk Assessment Before Noncardiac Surgery

10.1093/med/9780199392094.003.0014 ◽

2015 ◽

Author(s):

Wael AlJaroudi

Keyword(s):

Risk Assessment ◽

Preoperative Evaluation ◽

A Priori ◽

Cardiac Risk ◽

Cardiovascular Complications ◽

Noncardiac Surgery ◽

Therapeutic Interventions ◽

Increased Risk ◽

History Of ◽

Optimal Approach

Perioperative risk assessment is essential in screening patients before noncardiac surgery. Cardiovascular complications such as fatal and non-fatal myocardial infarction (MI), ventricular arrhythmia, pulmonary edema, and stroke are important in-hospital causes of morbidity and mortality intra and post-operatively. The optimal approach is to identify patients at increased risk so that appropriate testing and therapeutic interventions are undertaken a priori to minimize such risk. The initial preoperative evaluation includes identification of surgery-specific risk, patient exercise functional capacity and clinical risk profile. Patients with major predictors of events such as acute coronary syndromes, recent MI, unstable arrhythmia, and severe valvular disease warrant further management and optimization that often lead to delaying surgery. Those with three or more predictors (history of ischemic heart disease, compensated heart failure, diabetes, renal insufficiency, or history of cerebrovascular disease) undergoing high- risk surgery often require stress testing. Although data from randomized prospective trials are lacking, numerous studies have demonstrated the utility of myocardial perfusion imaging (MPI) for determination of perioperative cardiac risk. The goal of this chapter is to review the use of MPI for preoperative risk assessment and the recommendations from the current guidelines. The focus will be on short-term and long-term prognosis including special groups such as after coronary stenting and before vascular surgery, liver and renal transplantation.

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