Preoperative NT-proBNP Significance — FRCA Final MCQ

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ModeratePreoperative AssessmentPreoperative NT-proBNP SignificanceFRCA Final

A 65-year-old man (ASA III) is scheduled for a major abdominal operation. He has a cardiac history and the surgical team requests a pre-operative BNP level. His NT-proBNP is 850 pg/mL (normal <300). According to ESC/ESA guidelines, what does an elevated NT-proBNP indicate preoperatively?

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Correct answer: B — Increased risk of perioperative major adverse cardiac events – warrants further evaluation

An elevated preoperative NT-proBNP (or BNP) is an independent predictor of perioperative major adverse cardiac events (MACE) including MI, cardiac death, and heart failure. The ESC/ESA 2022 guidelines recommend measuring BNP/NT-proBNP in patients with ≥1 cardiovascular risk factor or poor functional capacity before high-risk surgery. An elevated level warrants: (1) optimisation of cardiac medications, (2) consideration of echocardiography, (3) enhanced perioperative monitoring (troponin surveillance, HDU bed), and (4) multidisciplinary discussion about risk-benefit.

Reference: ESC/ESA – 2022 – Non-cardiac surgery cardiovascular guidelines; RCOA – 2023 – Preoperative assessment