CHANGES IN THE LEVEL OF NT-proBNP AND MEAN PULMONARY ARTERY PRESSURE FOLLOWING BRONCHOPLASTIC LOBECTOMY OR PNEUMONECTOMY AS MARKERS OF RIGHT VENTRICULAR DYSFUNCTION

Background There are scanty data of right ventricular dysfunction markers after major pulmonary resection.

Objective To study the changes of plasma level of N-terminal pro-brain natriuretic peptide (NT-proBNP) and its association with pulmonary artery pressure (PAP) as markers of right ventricular dysfunction in patients who underwent bronchoplastic lobectomy or pneumonectomy.

Material and Methods The study population consisted of 36 patients aged 40–65 who underwent major  pulmonary resection for lung cancer in 2016–2018. Patients were stratified into two groups according to the type of surgical procedure: bronchoplastic lobectomy, the main group (n = 19), and pneumonectomy, control group (n = 17). They were then analyzed for plasma NT-proBNP concentration, operative time, blood loss, intraoperative fluid administration, intraoperative urine output, and mean PAP level before and after an operation.

Results The mean PAP level correlated positively with the plasma NT-proBNP concentration in the pneumonectomy group (Pearson r = 0.916754; p < 0.001). This correlation was no evident in the subset of patients undergoing bronchoplastic lobectomy at the same determination point (Pearson r = 0.234741; p = 0.330).

Conclusion The mean PAP increased significantly after pneumonectomy and is closely correlated with plasma  NTproBNP concentration. These findings support the conclusion that bronchoplasty is preferable over pneumonectomy for lung cancer patients.

1. Shalnova SA, Imaeva AE, Deev AD, et al. Elevated level of the natriuretic peptide among adult population in regions participating in the ESSE-RF study and its association with cardiovascular diseases and risk factors. Kardiologiia. 2017;57(12):43–52. PMID: 29466210. (In Russ.). https://doi.org/10.18087/cardio.2017.12.10065

2. Blyth KG, Groenning BA, Mark PB, et al. NT-proBNP can be used to detect right ventricular systolic dysfunction in pulmonary hypertension. Eur Respir J. 2007;29:737–774. PMID: 17135228. https://doi.org/10.1183/09031936.00095606

3. Tayama K, Takamori S, Mitsuoka M, Hayashi A, Tamura K, Mifune H. Natriuretic peptides after pulmonary resection. Ann Thorac Surg. 2002;73:1582–1586. PMID: 12022554. https://doi.org/10.1016/s0003-4975(02)03417-3

4. Ivanova SV, Vasyuk YuA, Shupenina EYu, Krikunov PV, Sadulaeva IA. Brain natriuretic peptide as biochemical marker for structural and functional heart disorders in arterial hypertension. Russian Journal of Cardiology. 2015;12(128):56–62. (In Russ.). https://doi.org/10.15829/1560-4071-2015-12-56-62

5. Detterbeck FC, Boffa DJ, Kim AW, Tanoue LT. The Eighth Edition Lung Cancer Stage Classification. Chest. 2017;151:193–203. PMID: 27780786. https://doi.org/10.1016/j.chest.2016.10.010

6. McCall PhJ, Arthur A, Glass A, et al. The right ventricular response to lung resection. J Thorac Cardiovasc Surg. 2019;158:556–565. PMID: 30826095. https://doi.org/10.1016/j.jtcvs.2019.01.067

7. Gaggin HK, Januzzi JL Jr. Biomarkers and diagnostics in heart failure. Biochim Biophys Acta. 2013;1832:2442–2450. PMID: 23313577. https://doi.org/10.1016/j.bbadis.2012.12.014

8. Levchenko EV, Levchenko NE, Yurin RI, et al. Long-term results of bronchoplastic surgical interventions in comparison with pneumonectomies in lung cancer. Voprosy onkologii = Problems in Oncology. 2017;63(2):234–240. (In Russ.). https://doi.org/10.37469/0507-3758-2017-63-2-234-239

9. Reshetov AV, Elkin AV, Nikolaev GV, Stepanov SS. Bronchoand angioplasty lobectomy as an alternative to pneumonectomy in treatment of non-small-cell lung cancer. Vestnik hirurgii imeni I.I. Grekova = Grekov’s Bulletin of Surgery. 2018;3:19–24. (In Russ.). https://doi.org/10.24884/0042-4625-2018-177-3-19-24

10. Bobbio A, Chetta A, Carbognani P, et al. Changes in pulmonary function test and cardio-pulmonary exercise capacity in COPD patients after lobar pulmonary resection. Eur J Cardiothorac Surg. 2005;28:754–758. PMID: 16140541. https://doi.org/10.1016/j.ejcts.2005.08.001

11. McLean AS, Huang SJ, Hyams S, et al. Prognostic values of B-type natriuretic peptide in severe sepsis and septic shock.Crit Care Med. 2007;35:1019–1026. PMID: 17334249. https://doi.org/10.1097/01.CCM.0000259469.24364.31

12. Wei B, D'Amico T, Samad Z, Hasan R, Berry MF. The impact of pulmonary hypertension on morbidity and mortality following major lung resection. Eur J Cardiothorac Surg. 2014;45:1028–1033. PMID: 24132298. PMCID: PMC4020383. https://doi.org/10.1093/ejcts/ezt495

13. Elrakhawy HM, Alassal MA, Shaalan AM, Awad AA, Sayed S, Saffan MM. Impact of major pulmonary resections on right ventricular function: early postoperative changes. Heart Surg Forum. 2018;21:009–017. PMID: 29485957. https://doi.org/10.1532/hsf.1864

14. Nagaya N, Nishikimi T, Okano Y, et al. Plasma brain natriuretic peptide levels increase in proportion to the extent of right ventricular dysfunction in pulmonary hypertension. J Am Coll Cardiol. 1998;31:202–208. PMID: 9426041. https://doi.org/10.1016/s0735-1097(97)00452-x

15. Maisel AS, Krishnaswamy P, Nowak RM, et al. Rapid measurement of B-type natriuretic peptide in the emergency diagnosis of heart failure. N Engl J Med. 2002;18:161–167. PMID: 12124404. https://doi.org/10.1056/NEJMoa020233

16. Leuchte HH, El Nounou M, Tuerpe JC, et al. N-terminal pro-brain natriuretic peptide and renal insufficiency as predictors of mortality in pulmonary hypertension. Chest. 2007;131:402–409. PMID: 17296640. https://doi.org/10.1378/chest.06-1758

17. Cagini L, Andolfi M, Leli C, et al. B-type natriuretic peptide following thoracic surgery: a predictor of postoperative cardiopulmonary complications. Eur J Cardiothorac Surg. 2014;46:74–80. PMID: 2535285. https://doi.org/10.1093/ejcts/ezu348

18. Tayama K, Mifune H, Takamori S, et al. Natriuretic peptides in the lung modulated by pneumonectomy. Ann Thorac Cardiovasc Surg. 1998;4:325–331. PMID: 9914460.