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

A.M.A. Berends; E. Buitenwerf; I.J. Riphagen; J.W.M. Lenders; H.J.L.M. Timmers; S. Kruijff; T.P. Links; A.N.A. van der Horst-Schrivers; C.A. Stegeman; E.M.W. Eekhoff; R.A. Feelders; E.P.M. Corssmit; R.G. Veldman; H.R. Haak; A.C.M. Kobold; M.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

A.M.A. Berends^*, E. Buitenwerf, I.J. Riphagen, J.W.M. Lenders, H.J.L.M. Timmers, S. Kruijff, T.P. Links, A.N.A. van der Horst-Schrivers, C.A. Stegeman, E.M.W. Eekhoff, R.A. Feelders, E.P.M. Corssmit, R.G. Veldman, H.R. Haak, A.C.M. Kobold, M.N. Kerstens

^*Corresponding author for this work

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

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 the 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 nor NT-proBNP were associated with blood pressure fluctuations. There was a positive correlation between MR-proADM concentration and the cumulative dose of vasoconstrictive agents (03B2 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 as 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
DOIs	https://doi.org/10.1530/eje-20-1452
Publication status	Published - 1 Oct 2021

Keywords

CARDIAC EVENTS
HEART
INFUSION
MIDREGIONAL PROADRENOMEDULLIN
NONCARDIAC SURGERY
PLASMA
PROGNOSTIC VALUE
PATIENT

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10.1530/eje-20-1452

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Berends, A. M. A., Buitenwerf, E., Riphagen, I. J., Lenders, J. W. M., Timmers, H. J. L. M., 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., Veldman, R. G., Haak, H. R., Kobold, A. C. M., & 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 the 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 nor NT-proBNP were associated with blood pressure fluctuations. There was a positive correlation between MR-proADM concentration and the cumulative dose of vasoconstrictive agents (03B2 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 as 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 = "CARDIAC EVENTS, HEART, INFUSION, MIDREGIONAL PROADRENOMEDULLIN, NONCARDIAC SURGERY, PLASMA, PROGNOSTIC VALUE, PATIENT",

author = "A.M.A. Berends and E. Buitenwerf and I.J. Riphagen and J.W.M. Lenders and H.J.L.M. Timmers and S. Kruijff and T.P. Links and {van der Horst-Schrivers}, A.N.A. and C.A. Stegeman and E.M.W. Eekhoff and R.A. Feelders and E.P.M. Corssmit and R.G. Veldman and H.R. Haak and A.C.M. Kobold and M.N. Kerstens",

year = "2021",

month = oct,

day = "1",

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",

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Berends, AMA, Buitenwerf, E, Riphagen, IJ, Lenders, JWM, Timmers, HJLM, Kruijff, S, Links, TP, van der Horst-Schrivers, ANA, Stegeman, CA, Eekhoff, EMW, Feelders, RA, Corssmit, EPM, Veldman, RG, Haak, HR, Kobold, ACM & 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, A.M.A.; Buitenwerf, E.; Riphagen, I.J. et al.
In: European Journal of Endocrinology, Vol. 185, No. 4, 01.10.2021, 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: a cross-sectional study

AU - Berends, A.M.A.

AU - Buitenwerf, E.

AU - Riphagen, I.J.

AU - Lenders, J.W.M.

AU - Timmers, H.J.L.M.

AU - Kruijff, S.

AU - Links, T.P.

AU - van der Horst-Schrivers, A.N.A.

AU - Stegeman, C.A.

AU - Eekhoff, E.M.W.

AU - Feelders, R.A.

AU - Corssmit, E.P.M.

AU - Veldman, R.G.

AU - Haak, H.R.

AU - Kobold, A.C.M.

AU - Kerstens, M.N.

PY - 2021/10/1

Y1 - 2021/10/1

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 the 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 nor NT-proBNP were associated with blood pressure fluctuations. There was a positive correlation between MR-proADM concentration and the cumulative dose of vasoconstrictive agents (03B2 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 as 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 the 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 nor NT-proBNP were associated with blood pressure fluctuations. There was a positive correlation between MR-proADM concentration and the cumulative dose of vasoconstrictive agents (03B2 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 as 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 - CARDIAC EVENTS

KW - HEART

KW - INFUSION

KW - MIDREGIONAL PROADRENOMEDULLIN

KW - NONCARDIAC SURGERY

KW - PLASMA

KW - PROGNOSTIC VALUE

KW - PATIENT

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 -