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.