N-terminal pro-brain natriuretiskt peptid och Högsensitivt Troponin T som screeningverktyg av okänd aortastenos vid höftfraktur hos äldre patienter

Abstract

Background: Aortic stenosis is the most common heart valve disease in the world. It is unknown for most people that they have an aortic stenosis due to normal aging or comorbidity, therefore most symptoms go disguised. Old people fall frequently and get hip fractures and sometimes this is due to but also the first sign of an unknown aortic stenosis (AS). Biomarkers such as NT-proBNP and hs-TnT are often used to estimate heart function in patients, such as coronary ischemia and heart failure. Aim: The purpose of this study was to examine if there is a correlation between elevated NT-proBNP and/or hs-TnT and unknown aortic stenosis among elderly patients prior to traumatic hip surgery. Method: This pilot observational study included 13 patients >75 years scheduled for hip surgery due to a fall. All participants were randomly selected. Pre- and 2-days postoperatively NT-proBNP and hs-TnT were analyzed. A postoperative ultrasound echocardiography (UCG) was performed on the patients to assess if an AS was present or not. The echocardiographic measurements were used to grade the degree of aortic stenosis (if present) to test our hypothesis. Results: 11/13 patients increased in both NT-proBNP and hs-TnT postoperative. 4/8 patients with AS had a NT-proBNP >1000ng/L preoperatively, levels noted in only 1/5 patients without AS. 7/8 patients with AS had a hs-TnT >11ng/L, whereas only 2/5 with no AS demonstrated this. Patients with AS had a mean increase of NT-proBNP by 440%, compared to 86% in those without AS. For hs-TnT there were a mean increase by 131% in AS, and 85% in those without AS. Conclusion: In this pilot study we found that 4/13 patients had moderate to severe AS, 4/13 had minor AS, while 5/13 had no AS. 11/13 patients had increased values in NT-proBNP over time while all patients (13/13) had enhanced hs-TnT over time. These results indicate that cardiac biomarkers enhance over time in this frail cohort of patients. Although, no direct correlation can be made between increased biomarkers and diagnosis of AS, which was anticipated in this pilot project. However, it seems likely that an enlarged future study may find a correlation.