Accuracy of Preoperative B-type Natriuretic Peptide Level in Predicting New Onset Atrial Fibrillation in Patients after Coronary Artery Bypass Grafting：A Systematic Review_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

MENG YanHai , CHANG Qian , WANG ShuiYun , ZHANG Haitao , ZHANG Yanbo.

Department of Cardiovascular Surgery，State Key Laboratory of Cardiovascular Disease，Fu Wai Hospital，National Center for Cardiovascular Disease ,Chinese Academy of Medical Sciences and Peking Union Medical College，Beijing100037，P. R. China;

Corresponding author：

Keywords：

B-type natriuretic peptide; 　Coronary artery bypass grafting; 　Atrial fibrillation

DOI：

10.7507/1007-4848.20130122

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Objective To evaluate the value of preoperative B-type natriuretic peptide （BNP） level in predicting new onset atrial fibrillation （AF） in patients after coronary artery bypass grafting （CABG）. Methods We electronically　searched PubMed，EMbase，Cochrane library，CNKI and VIP databases from the establishment of those databases to November　2012. Evaluation standard of diagnostic tests was used to identify and screen literatures which investigated correlations between　preoperative BNP levels and new onset AF of patients after CABG. Quality Assessment of Diagnostic Accuracy Studies （QUADAS） was used to evaluate study quality of included literatures. RevMan 5.0 was used for heterogeneity test. Meta-Disc　1.4 software was used for meta-analysis. Included studies were weighted and then combined. Sensitivity，specificity，diag-　nostic odds ratio （DOR），positive likelihood ratio，negative likelihood ratio and corresponding 95% confidence interval（95% CI）were calculated. Summary receiver operating characteristic （SROC） curve was drawn，and the area under the SROC curve （AUC） was analyzed. Results A total of 236 studies were identi?ed，and 5 studies met the eligibility criteria　including 802 patients for analysis. There were 228 patients with postoperative new onset AF，and 574 patients without postoperative AF. The quality of the included literature was relatively high. DOR of preoperative elevated BNP level with postoperative new onset AF was 4.15 with 95% CI 2.90 to 5.95. Pooled sensitivity was 0.78 with 95% CI 0.72 to 0.83，pooled specificity was 0.58 with 95% CI 0.54 to 0.58，pooled positive likelihood ratio was 1.91 with 95% CI 1.42 to 1.56，pooled negative likelihood ratio was 0.42 with 95% CI 0.32 to 0.54，and the AUC of SROC was 0.79 （Q=0.72）. Conclusion　Preoperative elevated BNP level is significantly correlated with new onset AF after CABG，is a powerful predictor of postoperative AF，and can be used to predict new onset AF after CABG to a certain extent of reliability.

Citation： MENG YanHai,CHANG Qian,WANG ShuiYun,ZHANG Haitao,ZHANG Yanbo.. Accuracy of Preoperative B-type Natriuretic Peptide Level in Predicting New Onset Atrial Fibrillation in Patients after Coronary Artery Bypass Grafting：A Systematic Review. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2013, 20(4): 381-386. doi: 10.7507/1007-4848.20130122 Copy

1.	Mathew JP， Parks R， Savino JS， et al. Atrial fibrillation following coronary artery bypass graft surgery：predictors， outcomes， and resource utilization. MultiCenter Study of Perioperative Ischemia Research Group. JAMA， 1996， 276：300-306.
2.	Usta E， Mustafi M， Walker T， et al. Resveratrol suppresses apoptosis　in intact human cardiac tissue - in vitro model simulating extracorporeal　circulation. J Cardiovasc Surg （Torino）， 2011， 52 （3）：399-409.
3.	Aranki SF， Shaw DP， Adams DH， et al. Predictors of atrial fibrillation after coronary artery surgery. Current trends and impact on hospital resources.Circulation， 1996， 94：390-397.
4.	Wang Z， Liang D， Fu Q， et al. Perioperative brain natriuretic peptide　in off-pump coronary artery bypass. Acta Cardiol， 2010， 65 （3）：297-301.
5.	Hutfless R， Kazanegra R， Madani M， et al. Utility of B-type natriuretic peptide in predicting postoperative complications and outcomes in patients undergoing heart surgery. J Am Coll Cardiol， 2004， 43 （10）：1873-1879.
6.	Sachdeva A， Horwich TB， Fonarow GC. Comparison of usefulness of each of five predictors of mortality and urgent transplantation in patients with advanced heart failure. Am J Cardiol， 2010， 106 （6）：830-835.
7.	Fellahi JL， Daccache G， Rubes D， et al. Does preoperative B-type natriuretic peptide better predict adverse outcome and prolonged length of stay than the standard European System for Cardiac Operative　Risk Evaluation after cardiac surgery ? J Cardiothorac Vasc Anesth， 2011， 25 （2）：256-262.
8.	Whiting P， Rutjes AW， Reitsma JB， et al. The development of QUADAS：a tool for the quality assessment of studies of diagnostic accuracy included in systematic reviews. BMC Med Res Methodol， 2003， 3：25.
9.	Krzych LJ， Szurlej D， Kooldziej T， et al. Diagnostic accuracy of pre-operative NT-proBNP level in predicting short-term outcomes in coronary surgery:A pilot study. Kardiol Pol， 2011， 69：1121-1127.
10.	Ata Y， Turk T， Ay D， et al. Ability of B-type natriuretic peptide in predicting postoperative atrial fibrillation in patients undergoing 　coronary artery bypass grafting. Heart Surg Forum， 2009， 12 （4）：E211-E216.
11.	Gibson PH， Croal BL， Cuthbertson BH， et al. Use of preoperative natriuretic peptides and echocardiographic parameters in predicting new-onset atrial fibrillation after coronary artery bypass grafting：a prospective comparative study. Am Heart J， 2009， 158 （2）：244-251.
12.	Akazawa T， Nishihara H， Iwata H， et al. Preoperative plasma brain natriuretic peptide level is an independent predictor of postoperative atrial fibrillation following off-pump coronary artery bypass surgery. J Anesth， 2008， 22 （4）：347-353.
13.	Sarzi Braga S， Vaninetti R， Pedretti RF. Plasma B-type natriuretic peptide predicts atrial fibrillation during rehabilitation after cardiac surgery. Eur J Cardiovasc Prev Rehabil， 2008， 15 （4）：460-466.
14.	Ketch TR， Turner SJ， Sacrinty MT， et al. Derived fibrinogen　compared with C-reactive protein and brain natriuretic peptide for predicting events after myocardial infarction and coronary stenting. Am Heart J， 2008， 156 （2）：234-240.
15.	Foroughi M， Rahimian H， Dabbagh A， et al. Postoperative N-terminal　pro-brain natriuretic peptide level in coronary artery bypass surgery with ventricular dysfunction after perioperative glucose-insulin-potassium treatment. J Cardiothorac Vasc Anesth， 2012， 26 （4）：631-636.
16.	Ambwani J， Ubhrani D， Saad R， et al. Best evidence topic-cardiac general could atrial natriuretic peptide be a useful drug therapy for high-risk patients after cardiac surgery?Interact Cardiovasc Thorac Surg， 2009， 8 （4）：474-478.
17.	Sezai A， Hata M， Wakui S， et al. Efficacy of low-dose continuous infusion of alpha-human atrial natriuretic peptide （hANP） during　cardiac surgery：possibility of postoperative left ventricular remodeling　effect. Circ J， 2006， 70 （11）：1426-1431.
18.	Karthikeyan G， Moncur RA， Levine O， et al. Is a pre-operative brain natriuretic peptide or N-Terminal Pro-B-Type natriuretic peptide　measurement an independent predictor of adverse cardiovascular outcomes within 30 days of noncardiac surgery ? A systematic review and meta-analysis of observational studies.J Am Coll Cardiol， 2009， 54 （17）：1599-1606.
19.	Blankenberg S， Tonkin A， Kirby A， et al. Incorporating novelbiomarkers significantly improves risk stratification for coronary heart disease patients：The long-term intervention with pravastatin in ischaemic disease （LIPID）trial. Circulation， 2011， 124：A15520.
20.	Tavakol M， Hassan KZ， Abdula RK， et al. Utility of brain natriuretic　peptide as a predictor of atrial fibrillation after cardiac operations. Ann Thorac Surg， 2009， 88 （3）：802-807.
21.	毛斌，陈菲，邵娟娟，等．非体外循环冠状动脉旁路移植术围术期脑钠肽变化特点及其临床意义．中国胸心血管外科临床杂志， 2011， 18 （4）：309-312．.
22.	Nashef SA， Roques F， Hammill BG， et al. Validation of European system for cardiac operative risk evaluation （EuroSCORE） in North American cardiac surgery. Eur J Cardiothorac Surg， 2002， 22 （1）：101-105.
23.	Litton E， Ho KM. The use of pre-operative brain natriuretic peptides as a predictor of adverse outcomes after cardiac surgery：a systematic review and meta-analysis. Eur J Cardiothorac Surg， 2012， 41 （3）：525-534.
24.	Yap CH， Mohajeri M， Ihle BU， et al. Validation of euroscore model in an Australian patient population. ANZ J Surg， 2005， 75 （7）：508-512.
25.	Toumpoulis IK， Anagnostopoulos CE， Swistel DG， et al. Does　EuroSCORE predict length of stay and specific postoperative complications after cardiac surgery ? Eur J Cardiothorac Surg， 2005， 27 （1）：128-133.
26.	Patel UD， Garg AX， Krumholz HM， et al. Preoperative serum brain　natriuretic peptide and risk of acute kidney injury after cardiac surgery.Circulation， 2012， 125 （11）：1347-1355.
27.	Evrard P， Gonzalez M， Jamart J， et al. Prophylaxis of supraventricular and ventricular arrhythmias after coronary artery bypass grafting　with low-dose sotalol. Ann Thorac Surg， 2000， 70 （1）：151-156.
28.	Karuppasamy P， Chaubey S， Dew T， et al. Remote intermittent ischemia before coronary artery bypass graft surgery:A strategy to reduce injury and inflammation?Basic Res Cardiol， 2011， 106 （4）：511-519.
29.	Steiner J， Guglin M. BNP or NTproBNP?A clinician's perspective. Int J Cardiol， 2008， 129：5-14.
30.	Masson S， Latini R， Anand IS， et al. Direct comparison of B-type natriuretic peptide （BNP） and amino-terminal proBNP in a large population of patients with chronic and symptomatic heart failure：the Valsartan Heart Failure （Val-HeFT） data. Clin Chem， 2006， 52 （8）：1528-1538.

1. 　Mathew JP， Parks R， Savino JS， et al. Atrial fibrillation following coronary artery bypass graft surgery：predictors， outcomes， and resource utilization. MultiCenter Study of Perioperative Ischemia Research Group. JAMA， 1996， 276：300-306.
2. 　Usta E， Mustafi M， Walker T， et al. Resveratrol suppresses apoptosis　in intact human cardiac tissue - in vitro model simulating extracorporeal　circulation. J Cardiovasc Surg （Torino）， 2011， 52 （3）：399-409.
3. 　Aranki SF， Shaw DP， Adams DH， et al. Predictors of atrial fibrillation after coronary artery surgery. Current trends and impact on hospital resources.Circulation， 1996， 94：390-397.
4. 　Wang Z， Liang D， Fu Q， et al. Perioperative brain natriuretic peptide　in off-pump coronary artery bypass. Acta Cardiol， 2010， 65 （3）：297-301.
5. 　Hutfless R， Kazanegra R， Madani M， et al. Utility of B-type natriuretic peptide in predicting postoperative complications and outcomes in patients undergoing heart surgery. J Am Coll Cardiol， 2004， 43 （10）：1873-1879.
6. 　Sachdeva A， Horwich TB， Fonarow GC. Comparison of usefulness of each of five predictors of mortality and urgent transplantation in patients with advanced heart failure. Am J Cardiol， 2010， 106 （6）：830-835.
7. 　Fellahi JL， Daccache G， Rubes D， et al. Does preoperative B-type natriuretic peptide better predict adverse outcome and prolonged length of stay than the standard European System for Cardiac Operative　Risk Evaluation after cardiac surgery ? J Cardiothorac Vasc Anesth， 2011， 25 （2）：256-262.
8. 　Whiting P， Rutjes AW， Reitsma JB， et al. The development of QUADAS：a tool for the quality assessment of studies of diagnostic accuracy included in systematic reviews. BMC Med Res Methodol， 2003， 3：25.
9. 　Krzych LJ， Szurlej D， Kooldziej T， et al. Diagnostic accuracy of pre-operative NT-proBNP level in predicting short-term outcomes in coronary surgery:A pilot study. Kardiol Pol， 2011， 69：1121-1127.
10. 　Ata Y， Turk T， Ay D， et al. Ability of B-type natriuretic peptide in predicting postoperative atrial fibrillation in patients undergoing 　coronary artery bypass grafting. Heart Surg Forum， 2009， 12 （4）：E211-E216.
11. 　Gibson PH， Croal BL， Cuthbertson BH， et al. Use of preoperative natriuretic peptides and echocardiographic parameters in predicting new-onset atrial fibrillation after coronary artery bypass grafting：a prospective comparative study. Am Heart J， 2009， 158 （2）：244-251.
12. 　Akazawa T， Nishihara H， Iwata H， et al. Preoperative plasma brain natriuretic peptide level is an independent predictor of postoperative atrial fibrillation following off-pump coronary artery bypass surgery. J Anesth， 2008， 22 （4）：347-353.
13. 　Sarzi Braga S， Vaninetti R， Pedretti RF. Plasma B-type natriuretic peptide predicts atrial fibrillation during rehabilitation after cardiac surgery. Eur J Cardiovasc Prev Rehabil， 2008， 15 （4）：460-466.
14. 　Ketch TR， Turner SJ， Sacrinty MT， et al. Derived fibrinogen　compared with C-reactive protein and brain natriuretic peptide for predicting events after myocardial infarction and coronary stenting. Am Heart J， 2008， 156 （2）：234-240.
15. 　Foroughi M， Rahimian H， Dabbagh A， et al. Postoperative N-terminal　pro-brain natriuretic peptide level in coronary artery bypass surgery with ventricular dysfunction after perioperative glucose-insulin-potassium treatment. J Cardiothorac Vasc Anesth， 2012， 26 （4）：631-636.
16. 　Ambwani J， Ubhrani D， Saad R， et al. Best evidence topic-cardiac general could atrial natriuretic peptide be a useful drug therapy for high-risk patients after cardiac surgery?Interact Cardiovasc Thorac Surg， 2009， 8 （4）：474-478.
17. 　Sezai A， Hata M， Wakui S， et al. Efficacy of low-dose continuous infusion of alpha-human atrial natriuretic peptide （hANP） during　cardiac surgery：possibility of postoperative left ventricular remodeling　effect. Circ J， 2006， 70 （11）：1426-1431.
18. 　Karthikeyan G， Moncur RA， Levine O， et al. Is a pre-operative brain natriuretic peptide or N-Terminal Pro-B-Type natriuretic peptide　measurement an independent predictor of adverse cardiovascular outcomes within 30 days of noncardiac surgery ? A systematic review and meta-analysis of observational studies.J Am Coll Cardiol， 2009， 54 （17）：1599-1606.
19. 　Blankenberg S， Tonkin A， Kirby A， et al. Incorporating novelbiomarkers significantly improves risk stratification for coronary heart disease patients：The long-term intervention with pravastatin in ischaemic disease （LIPID）trial. Circulation， 2011， 124：A15520.
20. 　Tavakol M， Hassan KZ， Abdula RK， et al. Utility of brain natriuretic　peptide as a predictor of atrial fibrillation after cardiac operations. Ann Thorac Surg， 2009， 88 （3）：802-807.
21. 　毛斌，陈菲，邵娟娟，等．非体外循环冠状动脉旁路移植术围术期脑钠肽变化特点及其临床意义．中国胸心血管外科临床杂志， 2011， 18 （4）：309-312．.
22. 　Nashef SA， Roques F， Hammill BG， et al. Validation of European system for cardiac operative risk evaluation （EuroSCORE） in North American cardiac surgery. Eur J Cardiothorac Surg， 2002， 22 （1）：101-105.
23. 　Litton E， Ho KM. The use of pre-operative brain natriuretic peptides as a predictor of adverse outcomes after cardiac surgery：a systematic review and meta-analysis. Eur J Cardiothorac Surg， 2012， 41 （3）：525-534.
24. 　Yap CH， Mohajeri M， Ihle BU， et al. Validation of euroscore model in an Australian patient population. ANZ J Surg， 2005， 75 （7）：508-512.
25. 　Toumpoulis IK， Anagnostopoulos CE， Swistel DG， et al. Does　EuroSCORE predict length of stay and specific postoperative complications after cardiac surgery ? Eur J Cardiothorac Surg， 2005， 27 （1）：128-133.
26. 　Patel UD， Garg AX， Krumholz HM， et al. Preoperative serum brain　natriuretic peptide and risk of acute kidney injury after cardiac surgery.Circulation， 2012， 125 （11）：1347-1355.
27. 　Evrard P， Gonzalez M， Jamart J， et al. Prophylaxis of supraventricular and ventricular arrhythmias after coronary artery bypass grafting　with low-dose sotalol. Ann Thorac Surg， 2000， 70 （1）：151-156.
28. 　Karuppasamy P， Chaubey S， Dew T， et al. Remote intermittent ischemia before coronary artery bypass graft surgery:A strategy to reduce injury and inflammation?Basic Res Cardiol， 2011， 106 （4）：511-519.
29. 　Steiner J， Guglin M. BNP or NTproBNP?A clinician's perspective. Int J Cardiol， 2008， 129：5-14.
30. 　Masson S， Latini R， Anand IS， et al. Direct comparison of B-type natriuretic peptide （BNP） and amino-terminal proBNP in a large population of patients with chronic and symptomatic heart failure：the Valsartan Heart Failure （Val-HeFT） data. Clin Chem， 2006， 52 （8）：1528-1538.

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Accuracy of Preoperative B-type Natriuretic Peptide Level in Predicting New Onset Atrial Fibrillation in Patients after Coronary Artery Bypass Grafting：A Systematic Review

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