Preoperative plasma B-type natriuretic peptide (BNP) identifies abnormal transthoracic echocardiography in elderly patients with traumatic hip fracture Injury, 05/17/2012

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.