Circulating adrenomedullin and B-type natriuretic peptide do not predict blood pressure fluctuations during pheochromocytoma resection: a cross-sectional study

Annika M A Berends; Edward Buitenwerf; Ineke Riphagen; Jacques Wm Lenders; Henri Jlm Timmers; S Kruijff; Thera P Links; Anouk N A van der Horst-Schrivers; Coen A Stegeman; Elisabeth M W Eekhoff; Richard A Feelders; Eleonora P M Corssmit; Ronald Groote Veldman; H R Haak; Anneke C Muller-Kobold; Michiel N Kerstens

doi:10.1530/EJE-20-1452

Circulating adrenomedullin and B-type natriuretic peptide do not predict blood pressure fluctuations during pheochromocytoma resection: a cross-sectional study

Annika M A Berends^*, Edward Buitenwerf, Ineke Riphagen, Jacques Wm Lenders, Henri Jlm Timmers, S Kruijff, Thera P Links, Anouk N A van der Horst-Schrivers, Coen A Stegeman, Elisabeth M W Eekhoff, Richard A Feelders, Eleonora P M Corssmit, Ronald Groote Veldman, H R Haak, Anneke C Muller-Kobold, Michiel N Kerstens

^*Corresponding author for this work

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Abstract

BACKGROUND: despite adequate presurgical management, blood pressure fluctuations are common during resection of pheochromocytoma or sympathetic paraganglioma (PPGL). To a large extent, the variability in blood pressure control during PPGL resection remains unexplained. Adrenomedullin and B-type natriuretic peptide, measured as MR-proADM and NT-proBNP, respectively, are circulating biomarkers of cardiovascular dysfunction. We investigated whether plasma levels of MR-proADM and NT-proBNP are associated with blood pressure fluctuations during PPGL resection.

METHODS: study subjects participated in PRESCRIPT, a randomized controlled trial in patients undergoing PPGL resection. MR-proADM and NT-proBNP were determined in a single plasma sample drawn before surgery. Multivariable linear and logistic regression analyses were used to explore associations between these biomarkers and blood pressure fluctuations, use of vasoconstrictive agents during surgery as well as occurrence of perioperative cardiovascular events.

RESULTS: a total of 126 PPGL patients were included. Median plasma concentrations of MR-proADM and NT-proBNP were 0.51 [0.41-0.63] nmol/L and 68.7 [27.9-150.4] ng/L, respectively. Neither MR-proADM or NT-proBNP were associated with blood pressure fluctuations. There was a positive correlation between MR-proADM concentration and the cumulative dose of vasoconstrictive agents (β 0.44 , P=0.001). Both MR-proADM and NT-proBNP were significantly associated with perioperative cardiovascular events (OR 5.46, P= 0.013 and OR 1.54, P= 0.017, respectively).

CONCLUSIONS: plasma MR-proADM or NT-proBNP should not be considered biomarkers for the presurgical risk assessment of blood pressure fluctuations during PPGL resection. Future studies are needed to explore the potential influence of these biomarkers on the intraoperative requirement of vasoconstrictive agents and the perioperative cardiovascular risk.

Original language	English
Pages (from-to)	507-514
Number of pages	8
Journal	European Journal of Endocrinology
Volume	185
Issue number	4
Early online date	1-Jul-2021
DOIs	https://doi.org/10.1530/EJE-20-1452
Publication status	Published - Oct-2021

Keywords

MIDREGIONAL PROADRENOMEDULLIN
NONCARDIAC SURGERY
PROGNOSTIC VALUE
CARDIAC EVENTS
PLASMA
INFUSION
HEART

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Berends, A. M. A., Buitenwerf, E., Riphagen, I., Lenders, J. W., Timmers, H. J., Kruijff, S., Links, T. P., van der Horst-Schrivers, A. N. A., Stegeman, C. A., Eekhoff, E. M. W., Feelders, R. A., Corssmit, E. P. M., Groote Veldman, R., Haak, H. R., Muller-Kobold, A. C., & Kerstens, M. N. (2021). Circulating adrenomedullin and B-type natriuretic peptide do not predict blood pressure fluctuations during pheochromocytoma resection: a cross-sectional study. European Journal of Endocrinology, 185(4), 507-514. https://doi.org/10.1530/EJE-20-1452

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title = "Circulating adrenomedullin and B-type natriuretic peptide do not predict blood pressure fluctuations during pheochromocytoma resection: a cross-sectional study",

abstract = "BACKGROUND: despite adequate presurgical management, blood pressure fluctuations are common during resection of pheochromocytoma or sympathetic paraganglioma (PPGL). To a large extent, the variability in blood pressure control during PPGL resection remains unexplained. Adrenomedullin and B-type natriuretic peptide, measured as MR-proADM and NT-proBNP, respectively, are circulating biomarkers of cardiovascular dysfunction. We investigated whether plasma levels of MR-proADM and NT-proBNP are associated with blood pressure fluctuations during PPGL resection.METHODS: study subjects participated in PRESCRIPT, a randomized controlled trial in patients undergoing PPGL resection. MR-proADM and NT-proBNP were determined in a single plasma sample drawn before surgery. Multivariable linear and logistic regression analyses were used to explore associations between these biomarkers and blood pressure fluctuations, use of vasoconstrictive agents during surgery as well as occurrence of perioperative cardiovascular events.RESULTS: a total of 126 PPGL patients were included. Median plasma concentrations of MR-proADM and NT-proBNP were 0.51 [0.41-0.63] nmol/L and 68.7 [27.9-150.4] ng/L, respectively. Neither MR-proADM or NT-proBNP were associated with blood pressure fluctuations. There was a positive correlation between MR-proADM concentration and the cumulative dose of vasoconstrictive agents (β 0.44 , P=0.001). Both MR-proADM and NT-proBNP were significantly associated with perioperative cardiovascular events (OR 5.46, P= 0.013 and OR 1.54, P= 0.017, respectively).CONCLUSIONS: plasma MR-proADM or NT-proBNP should not be considered biomarkers for the presurgical risk assessment of blood pressure fluctuations during PPGL resection. Future studies are needed to explore the potential influence of these biomarkers on the intraoperative requirement of vasoconstrictive agents and the perioperative cardiovascular risk.",

keywords = "MIDREGIONAL PROADRENOMEDULLIN, NONCARDIAC SURGERY, PROGNOSTIC VALUE, CARDIAC EVENTS, PLASMA, INFUSION, HEART",

author = "Berends, {Annika M A} and Edward Buitenwerf and Ineke Riphagen and Lenders, {Jacques Wm} and Timmers, {Henri Jlm} and S Kruijff and Links, {Thera P} and {van der Horst-Schrivers}, {Anouk N A} and Stegeman, {Coen A} and Eekhoff, {Elisabeth M W} and Feelders, {Richard A} and Corssmit, {Eleonora P M} and {Groote Veldman}, Ronald and Haak, {H R} and Muller-Kobold, {Anneke C} and Kerstens, {Michiel N}",

year = "2021",

month = oct,

doi = "10.1530/EJE-20-1452",

language = "English",

volume = "185",

pages = "507--514",

journal = "European Journal of Endocrinology",

issn = "0804-4643",

publisher = "BIOSCIENTIFICA LTD",

number = "4",

}

Berends, AMA, Buitenwerf, E, Riphagen, I, Lenders, JW, Timmers, HJ, Kruijff, S , Links, TP , van der Horst-Schrivers, ANA , Stegeman, CA, Eekhoff, EMW, Feelders, RA, Corssmit, EPM, Groote Veldman, R, Haak, HR, Muller-Kobold, AC & Kerstens, MN 2021, 'Circulating adrenomedullin and B-type natriuretic peptide do not predict blood pressure fluctuations during pheochromocytoma resection: a cross-sectional study', European Journal of Endocrinology, vol. 185, no. 4, pp. 507-514. https://doi.org/10.1530/EJE-20-1452

Circulating adrenomedullin and B-type natriuretic peptide do not predict blood pressure fluctuations during pheochromocytoma resection: a cross-sectional study. / Berends, Annika M A; Buitenwerf, Edward; Riphagen, Ineke et al.
In: European Journal of Endocrinology, Vol. 185, No. 4, 10.2021, p. 507-514.

Research output: Contribution to journal › Article › Academic › peer-review

TY - JOUR

T1 - Circulating adrenomedullin and B-type natriuretic peptide do not predict blood pressure fluctuations during pheochromocytoma resection

T2 - a cross-sectional study

AU - Berends, Annika M A

AU - Buitenwerf, Edward

AU - Riphagen, Ineke

AU - Lenders, Jacques Wm

AU - Timmers, Henri Jlm

AU - Kruijff, S

AU - Links, Thera P

AU - van der Horst-Schrivers, Anouk N A

AU - Stegeman, Coen A

AU - Eekhoff, Elisabeth M W

AU - Feelders, Richard A

AU - Corssmit, Eleonora P M

AU - Groote Veldman, Ronald

AU - Haak, H R

AU - Muller-Kobold, Anneke C

AU - Kerstens, Michiel N

PY - 2021/10

Y1 - 2021/10

N2 - BACKGROUND: despite adequate presurgical management, blood pressure fluctuations are common during resection of pheochromocytoma or sympathetic paraganglioma (PPGL). To a large extent, the variability in blood pressure control during PPGL resection remains unexplained. Adrenomedullin and B-type natriuretic peptide, measured as MR-proADM and NT-proBNP, respectively, are circulating biomarkers of cardiovascular dysfunction. We investigated whether plasma levels of MR-proADM and NT-proBNP are associated with blood pressure fluctuations during PPGL resection.METHODS: study subjects participated in PRESCRIPT, a randomized controlled trial in patients undergoing PPGL resection. MR-proADM and NT-proBNP were determined in a single plasma sample drawn before surgery. Multivariable linear and logistic regression analyses were used to explore associations between these biomarkers and blood pressure fluctuations, use of vasoconstrictive agents during surgery as well as occurrence of perioperative cardiovascular events.RESULTS: a total of 126 PPGL patients were included. Median plasma concentrations of MR-proADM and NT-proBNP were 0.51 [0.41-0.63] nmol/L and 68.7 [27.9-150.4] ng/L, respectively. Neither MR-proADM or NT-proBNP were associated with blood pressure fluctuations. There was a positive correlation between MR-proADM concentration and the cumulative dose of vasoconstrictive agents (β 0.44 , P=0.001). Both MR-proADM and NT-proBNP were significantly associated with perioperative cardiovascular events (OR 5.46, P= 0.013 and OR 1.54, P= 0.017, respectively).CONCLUSIONS: plasma MR-proADM or NT-proBNP should not be considered biomarkers for the presurgical risk assessment of blood pressure fluctuations during PPGL resection. Future studies are needed to explore the potential influence of these biomarkers on the intraoperative requirement of vasoconstrictive agents and the perioperative cardiovascular risk.

AB - BACKGROUND: despite adequate presurgical management, blood pressure fluctuations are common during resection of pheochromocytoma or sympathetic paraganglioma (PPGL). To a large extent, the variability in blood pressure control during PPGL resection remains unexplained. Adrenomedullin and B-type natriuretic peptide, measured as MR-proADM and NT-proBNP, respectively, are circulating biomarkers of cardiovascular dysfunction. We investigated whether plasma levels of MR-proADM and NT-proBNP are associated with blood pressure fluctuations during PPGL resection.METHODS: study subjects participated in PRESCRIPT, a randomized controlled trial in patients undergoing PPGL resection. MR-proADM and NT-proBNP were determined in a single plasma sample drawn before surgery. Multivariable linear and logistic regression analyses were used to explore associations between these biomarkers and blood pressure fluctuations, use of vasoconstrictive agents during surgery as well as occurrence of perioperative cardiovascular events.RESULTS: a total of 126 PPGL patients were included. Median plasma concentrations of MR-proADM and NT-proBNP were 0.51 [0.41-0.63] nmol/L and 68.7 [27.9-150.4] ng/L, respectively. Neither MR-proADM or NT-proBNP were associated with blood pressure fluctuations. There was a positive correlation between MR-proADM concentration and the cumulative dose of vasoconstrictive agents (β 0.44 , P=0.001). Both MR-proADM and NT-proBNP were significantly associated with perioperative cardiovascular events (OR 5.46, P= 0.013 and OR 1.54, P= 0.017, respectively).CONCLUSIONS: plasma MR-proADM or NT-proBNP should not be considered biomarkers for the presurgical risk assessment of blood pressure fluctuations during PPGL resection. Future studies are needed to explore the potential influence of these biomarkers on the intraoperative requirement of vasoconstrictive agents and the perioperative cardiovascular risk.

KW - MIDREGIONAL PROADRENOMEDULLIN

KW - NONCARDIAC SURGERY

KW - PROGNOSTIC VALUE

KW - CARDIAC EVENTS

KW - PLASMA

KW - INFUSION

KW - HEART

U2 - 10.1530/EJE-20-1452

DO - 10.1530/EJE-20-1452

M3 - Article

C2 - 34324433

SN - 0804-4643

VL - 185

SP - 507

EP - 514

JO - European Journal of Endocrinology

JF - European Journal of Endocrinology

IS - 4

ER -

Circulating adrenomedullin and B-type natriuretic peptide do not predict blood pressure fluctuations during pheochromocytoma resection: a cross-sectional study

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Keywords

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