Aminoterminal B-type Pro–Natriuretic Peptide as a Marker of Recovery After High-risk Coronary Artery Bypass Grafting in Patients With Ischemic Heart Disease and Severe Impaired Left Ventricular Function M. Rothenburger, MD, PhD, a J. Stypmann, MD, b C. Bruch, MD, PhD, b T. Wichter, MD, PhD, b M. Hoppe, a G. Drees, MD, a E. Berendes, MD, PhD, c G. Huelsken, MD, a,d A. Loeher, MD, H. Welp, MD, a C. Röttger, MD, a C. Schmid, MD, PhD, a H. H. Scheld, MD, PhD, a and T. D. T. Tjan, MD, PhD a Background: Aminoterminal B-type pro-natriuretic peptide (NT-proBNP) is a reliable indicator of heart failure severity. Levels of NT-proBNP are markedly increased in patients with coronary artery disease (CAD) and severely impaired left ventricular (LV) function. The aim of our study was to assess the impact of NT-proBNP levels after high-risk coronary artery bypass grafting (CABG) with regard to recovery potential. Methods: Between 1998 and 2004, 121 patients with CAD and severely impaired LV function, who were undergoing CABG, were investigated. Their mean age was 64  11 years. All patients were in New York Heart Association (NYHA) Class III/IV status; LV ejection fraction (EF) was 20  6%. All survivors underwent follow-up (59  34 months) spiroergometric, electrocardiographic (ECG) and echocardiographic assessment and were tested for routine blood controls and NT-proBNP levels (Roche, Mannheim, Germany). Results: The survival rate after 8 years was 70%. All survivors received follow-up assessment. Among survivors the median NT-proBNP level at follow-up was 896 (521 to 1,687) pg/ml. The maximum oxygen uptake was 14.6  4.9 ml/min/kg, and EF increased to 42% at follow-up among all survivors. On dichotomizing survivors into two groups with NT-proBNP levels above and below the median, the post-operative body mass index was significantly higher in the high NT-proBNP group (p  0.036). EF (p  0.028) and NYHA classification (p  0.05) improved significantly in both groups, with a tendency toward higher EF in the low NT-proBNP group. Conclusions: Patients undergoing a high-risk CABG procedure have a survival rate comparable to heart transplantation patients and show a potential for clinical and myocardial recovery. NT-proBNP use a useful marker for recovery after a high-risk CABG procedure, with significant correlation with clinical parameters. J Heart Lung Transplant 2006;25:596 – 602. Copyright © 2006 by the International Society for Heart and Lung Transplantation. Severe left ventricular dysfunction (ejection fraction [EF] 20%) is associated with markedly increased mor- tality rates. 1,2 The Framingham Study demonstrated that median survival time after the development of conges- tive heart failure is 1.7 years in men and 3.2 years in women. 1 Coronary artery disease (CAD) and end-stage heart failure have an even poorer prognosis than idio- pathic cardiomyopathy. 2–4 Because most cardiac sur- geons hesitate to proceed with surgery in this patient group due to the very high peri-operative mortality rates, ranging from 13% to 33%, cardiac transplantation has served as the “gold standard” in treatment of this clinical entity. 5,6 Recent studies have reported the benefit of high-risk coronary artery bypass grafting (CABG) procedures. 5–10 In the last 10 years, many centers have developed organized programs applying CABG in patients with ad- vanced ischemic cardiomyopathy. 5–12 Because the accu- mulated experience has been positive, the high-risk CABG procedure has become more common, despite the pres- ence of severe left ventricular dysfunction. Peri- and post-operative care has improved in recent years, resulting in acceptable survival rates. Reasons for these findings may involve both improved peri-opera- From the Department of a Thoracic and Cardiovascular Surgery, b Cardiology and Angiology and c Anesthesiology and Operative Intensive Care Medicine, and d Section of Telemedicine, Medical Statistics and Bioinformatics, University Hospital Muenster, Muenster, Germany. Submitted May 31, 2005; revised June 1, 2005; accepted December 27, 2005. Reprint requests: Markus Rothenburger, MD, PhD, Department of Thoracic and Cardiovascular Surgery, University Hospital Muen- ster, Albert-Schweitzer Strasse 33, 48129 Muenster, Germany. Telephone: 49-251-83-47401. Fax: 49-251-83-48316. E-mail: markus.rothenburger@ukmuenster.de Copyright © 2006 by the International Society for Heart and Lung Transplantation. 1053-2498/06/$–see front matter. doi:10.1016/ j.healun.2005.12.006 596 FAILING HEART—SURGICAL ASPECTS