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Clinical Chemistry and Laboratory Medicine (CCLM)

Published in Association with the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM)

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Volume 44, Issue 11

Issues

Evaluation of cardiac involvement following major orthopedic surgery

Martina Montagnana
  • Sezione di Chimica e Microscopia Clinica, Dipartimento di Scienze Morfologico-Biomediche, Università degli Studi di Verona, Verona, Italy
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Giuseppe Lippi
  • Sezione di Chimica e Microscopia Clinica, Dipartimento di Scienze Morfologico-Biomediche, Università degli Studi di Verona, Verona, Italy
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Dario Regis / Cristiano Fava
  • Dipartimento di Scienze Biomediche e Chirurgiche, Università degli Studi di Verona, Verona, Italy
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Gino Viola / Pietro Bartolozzi / Gian Cesare Guidi
  • Sezione di Chimica e Microscopia Clinica, Dipartimento di Scienze Morfologico-Biomediche, Università degli Studi di Verona, Verona, Italy
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
Published Online: 2011-09-21 | DOI: https://doi.org/10.1515/CCLM.2006.256

Abstract

Background: Cardiovascular morbidity is frequent after non-cardiac surgery and the early recognition of cardiac involvement is an essential tool for clinical risk stratification and management. The aim of this study was to investigate the behavior of traditional and emerging cardiac markers, including NT-prohormone-brain natriuretic peptide (NT-proBNP) and ischemia-modified albumin (IMA), in the perioperative period in patients undergoing major uncomplicated orthopedic surgery.

Methods: A total of 37 patients undergoing major orthopedic surgery were longitudinally evaluated for NT-proBNP, IMA, cardiac troponin T (cTnT), creatine kinase isoenzyme MB and myoglobin 3h before surgery and 4 and 72h thereafter.

Results: NT-proBNP values were significantly increased at 72h postoperative compared to both 3h preoperative and 4h postoperative (NT-proBNP: 20 vs. 4.5pmol/L, p<0.001 and 20 vs. 5.9pmol/L, p<0.001). IMA levels were significantly increased at 4 and 72h postoperative vs. 3h preoperative (132 vs. 113kU/L, p=0.02 and 151 vs. 113kU/L, p<0.001). In a stepwise regression model, the perioperative liquid amount and degree of modification in postoperative creatinine levels (delta-creatinine) were independently related to the NT-proBNP increase.

Conclusions: The significant increase observed in NT-proBNP suggests that patients undergoing major uncomplicated orthopedic surgery may develop subclinical cardiac stress, presumably attributable to the considerable infusion of liquids. The clinical significance of this finding deserves further investigation, especially in patients at higher risk of heart failure.

Clin Chem Med Lab 2006;44:1340–6.

Keywords: albumin cobalt binding; cardiac dysfunction; ischemia-modified albumin; NT-prohormone-brain natriuretic peptide; orthopedic surgery

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About the article

Corresponding author: Dr. Martina Montagnana, Sezione di Chimica e Microscopia Clinica, Dipartimento di Scienze Morfologico-Biomediche, Ospedale Policlinico G.B. Rossi, Piazzale Scuro, 10, 37134 Verona, Italy Fax: +39-045-8201889,


Received: 2006-07-18

Accepted: 2006-09-10

Published Online: 2011-09-21

Published in Print: 2006-11-01


Citation Information: Clinical Chemistry and Laboratory Medicine (CCLM), Volume 44, Issue 11, Pages 1340–1346, ISSN (Online) 1437-4331, ISSN (Print) 1434-6621, DOI: https://doi.org/10.1515/CCLM.2006.256.

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