Natriuretic Peptide Applications in Cardiac Surgery

Natriuretic peptides, principally B-type natriuretic peptide (BNP) and its inactive N-terminal fragment (NT-proBNP), have become indispensable biomarkers in the perioperative management of cardiac surgery. They offer objective quantification of myocardial stress, enabling refined risk stratification before surgery, early detection of postoperative ventricular dysfunction and guidance of therapeutic interventions. Their circulating concentrations correlate with left ventricular filling pressures, fluid shifts and neurohormonal activation, all of which are central to patient trajectories after procedures such as coronary artery bypass grafting and valvular repair. In recent years, these peptides have not only informed prognostic models but have also been incorporated into clinical algorithms for the diagnosis and grading of postoperative heart failure, optimisation of inotropic support and assessment of novel metabolic therapies designed to attenuate ischaemia–reperfusion injury. Their global uptake reflects both the accessibility of high-throughput assays and the growing emphasis on personalised perioperative care pathways that integrate biochemical markers with surgical and imaging data.

Research from Nature Portfolio

Recent work has evaluated the incremental value of preoperative BNP measurement alongside established risk scores. In a large prospective cohort, preoperative BNP was assessed in conjunction with a contemporary surgical risk model for the prediction of in-hospital mortality. While BNP levels independently correlated with postoperative outcomes, their addition to the risk model yielded no significant improvement in discrimination or calibration for mortality prediction. This finding underlines that although BNP remains a robust indicator of cardiac stress, its routine use as an adjunct to validated multivariable scores may be redundant when comprehensive clinical assessment and risk modelling are already in place.

Natriuretic Peptide Applications in Cardiac Surgery publication trend

The graph below shows the total number of articles in natriuretic peptide applications in cardiac surgery across all publications each year (not limited to Nature Index journals).

Technical terms

Natriuretic peptides: Cardiac-derived hormones that regulate fluid balance and vascular tone in response to myocardial stretch.

B-type natriuretic peptide (BNP): Active hormone secreted by ventricular myocytes under increased wall tension; used to diagnose and monitor heart failure.

N-terminal pro-BNP (NT-proBNP): Inactive precursor fragment with longer circulating half-life; reflects cumulative cardiac stress.

Coronary artery bypass grafting (CABG): Surgical revascularisation procedure that restores blood supply to ischaemic myocardium using autologous conduits.

EuroSCORE II: Multivariable algorithm estimating operative mortality risk in patients undergoing cardiac surgery.

Postoperative heart failure (PHF): New or worsening ventricular dysfunction that arises after cardiac surgery, often necessitating inotropic or mechanical support.

References

1. Effect of glutamate infusion on NT-proBNP after coronary artery bypass grafting in high-risk patients (GLUTAMICS II): A randomized controlled trial. PLOS Medicine (2022).
2. Effect of BNP on risk assessment in cardiac surgery patients, in addition to EuroScore II. Scientific Reports (2020).
3. Utility of NT-proBNP as an objective marker of postoperative heart failure after coronary artery bypass surgery: a prospective observational study. Perioperative Medicine (2021).
4. Impact of underlying heart disease per se on the utility of preoperative NT-proBNP in adult cardiac surgery. PLOS ONE (2018).