PDF(Pubmed)
Abstract：
Preoperative cardiovascular risk assessment is one of the main principles before noncardiac surgeries. Cardiac stress imaging, such as myocardial perfusion scan (MPS), is a proposed cardiovascular risk evaluation method according to the latest guidelines. Yet, its efficacy, along with the cost-effectiveness of the method, has been questioned in previous studies. Our study aims to evaluate the utility of N-terminal pro-b-type natriuretic peptide (NT-proBNP) level measurement in predicting postoperative cardiovascular complications in candidates who have undergone an MPS before surgery and compare the results.
A cohort of 80 patients with a revised cardiac risk index score of one or more who were scheduled for moderate to high-risk noncardiac surgeries and met the criteria to undergo an MPS for risk assessment were included in the study. All of them underwent an MPS one week before surgery. Their preoperative NT-proBNP, troponin levels, and electrocardiograms were obtained one day before surgery and again on day three postoperative. The predictive efficacy of NT-proBNP levels and MPS were compared.
Seventy-eight patients underwent surgery, three of which exhibited a rise in troponin level, six showed changes on electrocardiogram, and pulmonary edema was detected in one, three days after surgery. There was no mortality in our patients. The sensitivity and specificity of the MPS for predicting postoperative cardiovascular complications were 100% and 66%, respectively. MPS also had a positive predictive value of 20% and a negative predictive value of 100% in our study. A 332.5 pg/ml cut-off value for NT-proBNP level yielded a sensitivity of 100%, specificity of 79.2%, positive predictive value of 40%, and negative predictive value of 100%.
Our study reveals the incremental specificity and positive predictive value of NT-proBNP level measurement in preoperative cardiovascular risk evaluation compared to MPS. Given the low feasibility, high costs, and disappointing predictive value of MPS, preoperative NT-proBNP level assessment can be substituted. This method can assist anesthesiologists and surgeons with precisely detecting at-risk patients resulting in taking proper measures to reduce the morbidity and mortality of the proposed patients before and during surgeries.
A cohort of 80 patients with a revised cardiac risk index score of one or more who were scheduled for moderate to high-risk noncardiac surgeries and met the criteria to undergo an MPS for risk assessment were included in the study. All of them underwent an MPS one week before surgery. Their preoperative NT-proBNP, troponin levels, and electrocardiograms were obtained one day before surgery and again on day three postoperative. The predictive efficacy of NT-proBNP levels and MPS were compared.
Seventy-eight patients underwent surgery, three of which exhibited a rise in troponin level, six showed changes on electrocardiogram, and pulmonary edema was detected in one, three days after surgery. There was no mortality in our patients. The sensitivity and specificity of the MPS for predicting postoperative cardiovascular complications were 100% and 66%, respectively. MPS also had a positive predictive value of 20% and a negative predictive value of 100% in our study. A 332.5 pg/ml cut-off value for NT-proBNP level yielded a sensitivity of 100%, specificity of 79.2%, positive predictive value of 40%, and negative predictive value of 100%.
Our study reveals the incremental specificity and positive predictive value of NT-proBNP level measurement in preoperative cardiovascular risk evaluation compared to MPS. Given the low feasibility, high costs, and disappointing predictive value of MPS, preoperative NT-proBNP level assessment can be substituted. This method can assist anesthesiologists and surgeons with precisely detecting at-risk patients resulting in taking proper measures to reduce the morbidity and mortality of the proposed patients before and during surgeries.
摘要：
背景：术前心血管风险评估是非心脏手术前的主要原则之一。心脏负荷成像,如心肌灌注扫描（MPS），是根据最新指南提出的心血管风险评估方法。然而，其功效,以及该方法的成本效益，在以前的研究中受到质疑。我们的研究旨在评估N末端B型利钠肽前体（NT-proBNP）水平测量在预测手术前接受MPS的候选人的术后心血管并发症中的实用性，并比较结果。
方法：本研究纳入了80例患者的队列，这些患者的心脏风险指数评分修正为1名或1名以上，计划进行中高风险非心脏手术，并符合接受MPS风险评估的标准。他们都在手术前一周接受了MPS。术前NT-proBNP,肌钙蛋白水平,并在手术前一天和术后第三天再次获得心电图。比较NT-proBNP水平和MPS的预测效果。
结果：78名患者接受了手术，其中三个显示肌钙蛋白水平上升，六个显示心电图变化，在一个人中发现了肺水肿，手术后三天。我们的病人没有死亡。MPS预测术后心血管并发症的敏感性和特异性分别为100%和66%,分别。在我们的研究中，MPS的阳性预测值为20％，阴性预测值为100％。NT-proBNP水平的332.5pg/ml截止值产生100%的灵敏度,特异性为79.2%，阳性预测值为40%，阴性预测值为100%。
结论：我们的研究揭示了与MPS相比，NT-proBNP水平测量在术前心血管风险评估中的增量特异性和阳性预测值。由于可行性较低，高成本,MPS的预测价值令人失望，术前NT-proBNP水平评估可以替代。该方法可以帮助麻醉师和外科医生精确地检测有风险的患者,从而在手术之前和手术期间采取适当的措施来降低所提出的患者的发病率和死亡率。
方法：本研究纳入了80例患者的队列，这些患者的心脏风险指数评分修正为1名或1名以上，计划进行中高风险非心脏手术，并符合接受MPS风险评估的标准。他们都在手术前一周接受了MPS。术前NT-proBNP,肌钙蛋白水平,并在手术前一天和术后第三天再次获得心电图。比较NT-proBNP水平和MPS的预测效果。
结果：78名患者接受了手术，其中三个显示肌钙蛋白水平上升，六个显示心电图变化，在一个人中发现了肺水肿，手术后三天。我们的病人没有死亡。MPS预测术后心血管并发症的敏感性和特异性分别为100%和66%,分别。在我们的研究中，MPS的阳性预测值为20％，阴性预测值为100％。NT-proBNP水平的332.5pg/ml截止值产生100%的灵敏度,特异性为79.2%，阳性预测值为40%，阴性预测值为100%。
结论：我们的研究揭示了与MPS相比，NT-proBNP水平测量在术前心血管风险评估中的增量特异性和阳性预测值。由于可行性较低，高成本,MPS的预测价值令人失望，术前NT-proBNP水平评估可以替代。该方法可以帮助麻醉师和外科医生精确地检测有风险的患者,从而在手术之前和手术期间采取适当的措施来降低所提出的患者的发病率和死亡率。
