Preoperative plasma B-type natriuretic peptide (BNP) identifies abnormal transthoracic echocardiography in elderly patients with traumatic hip fracture
Pili–Floury S et al. – The incidence of echocardiographic signs of elevated pulmonary artery pressure (PAPs) or elevated left ventricular filling pressure (LVFP) in elderly hip–fractured patients was high. A preoperative brain natriuretic peptide (BNP) value ≥285pgml-1 can discriminate between elderly hip–fractured patients with or without major echocardiographic abnormality (MEA).
Preoperative plasma BNP measurement and rest transthoracic echocardiography (TTE) were performed within 24h after admission in consecutive hip-fractured patients aged ≥65years.
The major echocardiographic abnormality (MEA) group included patients with at least one TTE abnormality, defined as systolic pulmonary artery pressure (PAPs) ≥50mmHg, left ventricular (LV) systolic dysfunction, increased LV filling pressure (LVFP) or severe valvular disease.
The control group included the remaining patients.
Seventy-five patients (mean±SD (range) age=85±5 (69–97)years) were included during a 6-month period.
Twenty-four (32%) patients constituted the MEA group (17 elevated PAPs, three LV systolic dysfunctions, 10 increased LVFP, one severe aortic stenosis and one severe mitral regurgitation).
Median (interquartile) preoperative BNP value was significantly greater in MEA than in the control group (527 (361) vs. 119 (154)pgml-1; p<0.0001).
A preoperative plasma BNP cut-off value at 285pgml-1 predicted well MEA with an area under the receiver operating characteristic (ROC) curve equal to 0.895 (p<0.0001) and with a hazard ratio (HR) (confidence interval, CI) of 23.8 (3.7–142.9) (p=0.0008) on multivariate analysis.
The presence of MEA or BNP≥285pgml-1 was associated with high mortality.
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