Perioperative Levels of Troponin and BNP and the Outcome after Coronary Artery Bypass Grafting.

BACKGROUND: The independent predictive values of troponin I (cTnI) and B-type natriuretic peptide (BNP) after coronary artery bypass grafting (CABG) have been reported in several studies. However, adjustment only has been limited to preoperative risk factors. AIM: This study was conducted to assess the independent values of postoperative cTnI and BNP to predict the outcome after CABG with adjustment for preoperative risk estimates and postoperative complications and to report risk stratification gains, when considering the European System for Cardiac Operative Risk Evaluation (EuroSCORE) combined with postoperative biomarkers. METHODS: This retrospective cohort study included 282 consecutive patients undergoing CABG between January 2018 and December 2021. We evaluated the preoperative and postoperative cTnI and BNP, EuroSCORE, and postoperative complications. The composite endpoint was death or cardiac-related adverse events. RESULTS: The AUROC for postoperative cTnI was significantly higher than that of BNP (0.777 vs. 0.625, p = 0.041). The optimal cut-off values to predict the composite outcome were >4830 (pg/mL) and >6.95 (ng/mL) for BNP and cTnI, respectively. Adjustment for relevant and significant perioperative factors showed that postoperative BNP and cTnI had a high discriminatory power (C-index = 0.773 and 0.895, respectively) for predicting major adverse events. CONCLUSIONS: Postoperative BNP and cTnI are independent predictors of death or major adverse events, following CABG, and can add to the predictive power of EuroSCORE II.

Differentiating Characteristics and Responses to Treatment of New-Onset Heart Failure With Preserved and Reduced Ejection Fraction in Ambulatory Patients.

Background: Differences in clinical presentation and therapy outcomes between heart failure with preserved ejection fraction (HFpEF) and heart failure with reduced ejection fraction (HFrEF) have been reported but described mainly among hospitalized patients. Because the population of outpatients with heart failure (HF) is increasing, we sought to discriminate the clinical presentation and responses to medical therapy in ambulatory patients with new-onset HFpEF vs. HFrEF. Methods: We retrospectively included all patients with new-onset HF treated at a single HF clinic in the past 4 years. Clinical data and electrocardiography (ECG) and echocardiography findings were recorded. Patients were followed up once weekly, and treatment response was evaluated according to symptoms resolution within 30 days. Univariate and multivariate regression analyses were performed. Results: A total of 146 patients were diagnosed with new-onset HF: 68 with HFpEF and 78 with HFrEF. The patients with HFrEF were older than those with HFpEF (66.9 vs. 62 years, respectively, P = 0.008). Patients with HFrEF were more likely to have coronary artery disease, atrial fibrillation, or valvular heart disease than those with HFpEF (P < 0.05 for all). Patients with HFrEF rather than HFpEF were more likely to present with New York Heart Association class 3 - 4 dyspnea, orthopnea, paroxysmal nocturnal dyspnea or low cardiac output (P < 0.007 for all). Patients with HFpEF were more likely than those with HFpEF to have normal ECG at presentation (P < 0.001), and left bundle branch block (LBBB) was observed only in patients with HFrEF (P < 0.001). Resolution of symptoms within 30 days occurred in 75% of patients with HFpEF and 40% of patients with HFrEF (P < 0.001). Conclusions: Ambulatory patients with new-onset HFrEF were older, and had higher incidence of structural heart disease, in comparison to those with new-onset HFpEF. Patients presenting with HFrEF had more severe functional symptoms than those with HFpEF. Patients with HFpEF were more likely than those with HFpEF to have normal ECG at the time of presentation, and LBBB was strongly associated with HFrEF. Outpatients with HFrEF rather than HFpEF were less likely to respond to treatment.