Early Postoperative Echocardiographic and Natriuretic Peptide Changes Following Anatomical Lung Resection: A Single-Center Cohort Study.

Background/

Objectives

Anatomical lung resection removes part of the pulmonary vascular bed and may acutely alter right ventricular loading conditions. The magnitude and the clinical significance of these early changes remain incompletely characterized, and it is unclear whether early echocardiographic changes relate to postoperative complications. This study aimed primarily to characterize the perioperative echocardiographic response to lung resection, while associations with any postoperative complication and with a cardiopulmonary composite outcome were evaluated as a secondary, exploratory analysis.

Methods

This prospective, single-center observational study included 40 adult patients undergoing lung resection for suspected or confirmed lung cancer. Transthoracic echocardiography was performed preoperatively and on the first postoperative day, and N-terminal pro-B-type natriuretic peptide (NT-proBNP) was measured preoperatively and at 24 h. Assessed parameters included left ventricular ejection fraction (LVEF), tricuspid annular plane systolic excursion (TAPSE), systolic pulmonary artery pressure (PASP), peak tricuspid regurgitation velocity (TRV), the TAPSE/PASP coupling ratio and NT-proBNP. The primary outcome was the paired perioperative change in those measurements. Paired comparisons used the Wilcoxon signed-rank test with matched-pairs rank-biserial correlations and bootstrap confidence intervals; exploratory comparisons used Mann-Whitney U tests and areas under the receiver operating characteristic curve (AUC) with bootstrap confidence intervals. Multivariable modeling was not performed.

Results

All six parameters changed significantly between the preoperative and postoperative assessments. PASP increased by a median of 4.0 mmHg (p < 0.001) and TRV max by 0.10 m/s (p < 0.001), while TAPSE decreased by 0.10 cm (p = 0.015) and LVEF by 2.0 percentage points (p = 0.001). The right ventricular-pulmonary arterial (RV-PA) coupling ratio declined from 0.717 to 0.526 mm/mmHg (p < 0.001) and NT-proBNP rose from 82.5 to 229.0 pg/mL (p < 0.001). Sixteen patients (40.0%) developed any complication and seven (17.5%) developed a cardiopulmonary complication. No echocardiographic parameter showed statistically supported discrimination for either outcome; all corresponding confidence intervals for the AUC included 0.50. NT-proBNP measured at 24 h and its perioperative change showed nominal associations with complication status, whereas the preoperative concentration did not. All recorded complications were documented before the 24-h blood draw.

Conclusions

Anatomical lung resection was followed by statistically detectable changes in measured echocardiographic indices by the first postoperative day. The cohort-level increase in pulmonary pressures and the decline in RV-PA coupling were the most clearly supported findings, whereas the small changes in TAPSE and LVEF are of uncertain biological magnitude. No echocardiographic parameter showed statistically supported discrimination between patients who did and did not develop complications, as estimates were imprecise, with wide confidence intervals. The association with 24-h NT-proBNP was post-event and therefore cannot be interpreted as evidence of predictive value.