Plasma B-type natriuretic peptide in predicting outcomes of elective coronary artery bypass surgery.

The risks of surgery and its clinical outcome are of great importance for both patients and physicians when choosing coronary artery bypass (CABG) surgery for coronary artery disease. The purpose of the current study was to clarify the relationship between serum B-type natriuretic peptide (BNP) and patient clinical outcome. Seventy-six eligible patients who underwent CABG were enrolled into the prospective study. Venous blood samples were drawn for serum BNP and N-terminal (NT)-proBNP levels measurement on preoperative Day 1, postoperative Day 1, and postoperative Day 7. Clinical end points were: (1) intensive care unit (ICU) stay longer than 4 days postoperatively and/or hospital stay longer than 13 days postoperatively; (2) major complications and poor outcomes. Patients who had prolonged ICU stay and hospitalization had significantly higher postoperative Day 1 BNP and postoperative Day 1 NT-proBNP level (p = 0.02 and 0.005, respectively). Age was significantly older in patients with prolonged ICU stay and hospitalization than those without prolonged ICU stay and hospitalization (p = 0.03). Serum creatinine level was also significantly increased in patients with prolonged ICU stay and hospitalization (p = 0.009). However, age was the only remaining factor that correlated with prolonged ICU stay and hospitalization in the multivariate logistic regression model. These results suggest that research using BNP and NT-proBNP for predicting ICU stay and hospitalization in patients who have undergone CABG must adjust risk factors to present a more appropriate estimation of its clinical outcome.

The correlation between three-dimensional vena contracta area and aortic regurgitation index in patients with aortic regurgitation.

OBJECTIVES: The aims of this study are to explore the correlation between the three-dimensional vena contracta (3D VC) area and the aortic regurgitation (AR) index and to determine AR severity using the 3D VC area. BACKGROUND: The geometry of regurgitant jets is complex in patients with AR. The 3D VC area can be easily cropped using any plane and we can obtain the complex geometry of the VC area. METHODS: Full-volume three-dimensional (3D) color flow datasets were generated using the trans-thoracic parasternal approach. The AR jet could be well visualized and analyzed in three orthogonal planes using dedicated software. RESULTS: We consecutively analyzed 77 AR patients with comprehensive 2D and 3D echocardiographic data. The 3D VC area increased proportionately with increasing AR severity using the AR index method (F = 86.1, P < 0.001) and correlated well with effective regurgitant orifice (P < 0.001). The cutoff value of the VC area was < 30 mm(2) (sensitivity = 90% and specificity = 88%) for predicting mild AR and > 50 mm(2) (sensitivity = 92% and specificity = 87%) for predicting severe AR. CONCLUSION: 3D color flow VC area measurement provides a simple and accurate method for assessing the severity of AR.

Prediction of severity of isolated aortic regurgitation by echocardiography: an aortic regurgitation index study.

BACKGROUND: No single precise qualitative method is recommended for evaluating the severity of aortic regurgitation (AR). Quantitative methods for AR assessment are, typically, cumbersome and time-consuming. The purpose of this study was to develop a more comprehensive method for predicting the severity of AR. METHODS: In all, 79 patients with normal left ventricular systolic function and at least mild AR were included in this prospective study. The standard references for evaluating AR severity were quantitative methods. The AR index consisted of 5 echocardiographic parameters: jet width ratio, vena contracta width, pressure half-time, jet density, and diastolic flow reversal in the descending aorta. Each parameter was scored on a 3-point scale from 1 to 3. The AR index was calculated as the sum of each score divided by the number of parameters. Thus, an increasing AR index score from 1 to 3 was indicative of increasing regurgitation. RESULT: The study demonstrated that the numeric value of AR index increased proportionately to the quantitative grading of AR severity, and proved to be an accurate predictor for AR severity. A 1.8 threshold for the AR index offered a high level of sensitivity and negative predictive value for severe AR. The possibility of missing severe AR was low with AR index less than 1.8. A 2.6 threshold for the AR index provided high specificity and positive predictive value for severe AR. The possibility of diagnosing severe AR was extremely high with AR index of 2.6 or more. CONCLUSION: AR index provided a more comprehensive method for predicting the degree of AR severity in this study. We suggest that the AR index should be considered for any evaluation of the severity of AR.

Value of parasternal long-axis vena contracta width for predicting severity of aortic regurgitation in left ventricular systolic dysfunction.

Correlations derived for the relations between parasternal long-axis vena contracta width and effective regurgitant orifice area, regurgitant volume, and regurgitant fraction were highly significant. A vena contracta width of <3.0 or >5.0 mm provided excellent specificity for nonsevere and severe aortic regurgitation, respectively.