Preoperative Cardiac Screening using NT-proBNP in Obese Patients Aged ≥50 years Undergoing Bariatric Surgery: a Study of 310 Consecutive Patients
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SourceSurgery for Obesity and Related Diseases, 17, 1, (2021), pp. 64-71
Article / Letter to editor
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Surgery for Obesity and Related Diseases
SubjectRadboudumc 16: Vascular damage RIHS: Radboud Institute for Health Sciences
Introduction: Obesity is associated with cardiovascular (CV) risk factors and diseases. Because bariatric surgery is increasingly performed in relatively elderly patients, a risk for per- and postoperative CV complications exists. Objectives: We aimed to assess the value of plasma N-terminal-pro hormone BNP (NT-proBNP) as a CV screening tool. Setting: High-volume bariatric center Methods: Between June 2019 and January 2020, all consecutive bariatric patients aged ≥50 years underwent pre-operative NT-proBNP assessment in this cohort study, to screen for CV disease. Patients with elevated NT-proBNP (≥125 pg/ml) were referred for further cardiac evaluation, including electrocardiography and echocardiography. Results: We included 310 consecutive patients (median age 56 years, 79% female, body mass index 43±6.5 kg/m2). A history of CV disease was present in 21% of patients, mainly atrial fibrillation (7%) and coronary artery disease (10%). 72 patients (23%) had elevated NT-proBNP levels, and 67 of them underwent further cardiac work-up. Of these 67 patients, electrocardiography showed atrial fibrillation in 7 patients (10%). On echocardiography, three patients had left ventricular ejection fraction (LVEF) <40%, nine patients had LVEF 40-49%, and 13 patients had LVEF ≥50% with structural and/or functional remodeling. In two patients, elevated NT-proBNP prompted work-up leading to a diagnosis of coronary artery disease, and consequent percutaneous coronary intervention in one patient. Conclusion: Elevated NT-proBNP levels are present in 23% of patients ≥50 years undergoing bariatric surgery. In 37% of them, there was echocardiographic evidence for structural and/or functional remodeling. Further studies are needed to assess if these preliminary results warrant routine application of NT-proBNP to identify patients at risk for CV complications after bariatric surgery. Publisher: Abstract available from the publisher.
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