Preoperative Cardiac Screening using NT-proBNP in Obese Patients Aged ≥50 years Undergoing Bariatric Surgery: a Study of 310 Consecutive Patients.

van Veldhuisen, Sophie L.; van Woerden, Gijs; Hemels, Martin EW.; America, Yves GCJ.; de Boer, Rudolf A.; Rienstra, Michiel; van Veldhuisen, Dirk J.; Hazebroek, Eric J.

INTRODUCTION: Obesity is associated with cardiovascular (CV) risk factors and diseases. Because bariatric surgery is increasingly performed in relatively elderly patients, a risk for per- and postoperative CV complications exists. OBJECTIVES: We aimed to assess the value of plasma N-terminal-pro hormone BNP (NT-proBNP) as a CV screening tool. SETTING: High-volume bariatric center METHODS: Between June 2019 and January 2020, all consecutive bariatric patients aged ≥50 years underwent pre-operative NT-proBNP assessment in this cohort study, to screen for CV disease. Patients with elevated NT-proBNP (≥125 pg/ml) were referred for further cardiac evaluation, including electrocardiography and echocardiography. RESULTS: We included 310 consecutive patients (median age 56 years, 79% female, body mass index 43±6.5 kg/m(2)). A history of CV disease was present in 21% of patients, mainly atrial fibrillation (7%) and coronary artery disease (10%). 72 patients (23%) had elevated NT-proBNP levels, and 67 of them underwent further cardiac work-up. Of these 67 patients, electrocardiography showed atrial fibrillation in 7 patients (10%). On echocardiography, three patients had left ventricular ejection fraction (LVEF) <40%, nine patients had LVEF 40-49%, and 13 patients had LVEF ≥50% with structural and/or functional remodeling. In two patients, elevated NT-proBNP prompted work-up leading to a diagnosis of coronary artery disease, and consequent percutaneous coronary intervention in one patient. CONCLUSION: Elevated NT-proBNP levels are present in 23% of patients ≥50 years undergoing bariatric surgery. In 37% of them, there was echocardiographic evidence for structural and/or functional remodeling. Further studies are needed to assess if these preliminary results warrant routine application of NT-proBNP to identify patients at risk for CV complications after bariatric surgery.