Effect Levosimendan Administration on Postoperative NT-proBNP in Cardiac Risk Patients

Inclusion Criteria

• •All patients need to meet all of the following criteria for inclusion (1-4):
• •1. Undergoing major surgery planned for more than 2 hours
• •2. ≥ 65 years of age and ≤ 85 years of age
• •3. Provide written informed consent AND
• •4. Fulfill ≥ 2 of the following criteria (A-E)
• •A) NT-proBNP ≥ 200 ng/L
• •B) History of coronary artery disease defined as 1 of the following 7 criteria (I to VII):
• •I) History of angina
• •II) History of myocardial infarction or acute coronary syndrome
• •III) History of a segmental cardiac wall motion abnormality on echocardiography/radionuclide imaging
• •IV) History of positive myocardial stress test (echocardiographic or radionuclide)
• •V) History of a coronary artery stenosis \> 50%
• •VI) ECG with pathological Q waves in any two contiguous leads
• •VII) History of previous artery revascularizations
• •C) History of permanent/paroxysmal atrial fibrillation diagnosed by physician/specialist
• •D) History of peripheral arterial disease as defined by a physician/specialist diagnosis of a current, or prior history of any 1 of the following 5criteria (I-V)
• •I) Intermittent claudication
• •II) Stenosis ≥ 70 % detected by angiography or doppler
• •III) Stenosis ≤ 70% detected by angiography or doppler AND requiring medical treatment e.g. ASA or other platelet inhibitor
• •IV) History of stroke or TIA - diagnosed by physician or CT/MRI
• •V) Diagnosed cerebral arteriovascular disease (cAVK) diagnosed by a physician/specialist
• •E) Any 3 of 10 of the following risk criteria (i - x).
• •i. History of congestive heart failure defined as a physician diagnosis of a current or prior episode of congestive heart failure OR prior radiographic evidence of vascular redistribution, interstitial pulmonary edema, or frank alveolar pulmonary edema;
• •ii. History of a transient ischemic attack;
• •iii. Diabetes and currently taking an oral hypoglycemic agent or insulin;
• •iv. History of hypertension;
• •v. Hyperlipidemia and currently taking a lipid lowering agent;
• •vi. Documented chronic kidney disease diagnosed by physician/specialist and creatinine clearance \> 30 ml/min
• •vii. History of smoking within 2 years of surgery
• •viii. Diastolic dysfunction (≥ grade 1) documented by echocardiography
• •ix. Age ≥ 70 years
• •x. Preoperative Troponin T (5th generation) ≥ 25ng/dL