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Indexed/Abstracted in: BIOSIS Previews, Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
Impact Factor 1,632
Online ISSN 1827-191X
Langenbach M. R. 1, Korbmacher B. 2, Schulte H. 2, Zirngibl H. 1, Grabensee B. 3, Plum J. 3
1 Department of Surgery University Witten-Herdecke, Wuppertal, Germany
2 Department of Thoracic and Cardiovascular Surgery
3 Department of Nephrology and Rheumatology University of Düsseldorf, Düsseldorf, Germany
Background. Hypothesis: increased ANP levels after uncomplicated coronary artery surgery (CAS) indicate functional reduction.
Methods. Experimental design: prospective, randomized. Preoperative upto the 12 week postoperative. Setting: Thoracic and Cardiovascular Surgery, University of Düsseldorf. Patients: 15 patients (mean age: 58±6.1 years; 13 months, 2 weeks; no myocardial infarction, no congestive heart failure) with 3 vessel disease. Interventions: levels of atrial natriuretic peptide (ANP) (pg/ml; radioimmunassay), Troponin T (TnT) (ng/ml; ELISA test), haemodynamic parameters, ECG monitoring, m-mode echocardiography (Echo). Measures: increase of ANP, TnT levels during extracorporeal circulation (ECC), decrease after operation.
Results. Maximal increase of ANP from preoperative 90±10 (M±SEM) pg/ml (p<0.05) up to intraoperative 380±38 pg/ml. Ten days postoperative ANP (26±33 pg/ml) still threefold increased compared to preoperative level. Increasement of TnT from preoperative 0.02±0.01 ng/ml upto intraoperative 3.44±0.47 ng/ml. Ten days postoperative TnT concentration normal (0.13±0.11 ng/ml). Correlation of ANP and TnT five min after bypass up to 6 hrs postoperative (p<0.05, r =3.4). Increase of left atrial diameter preoperative 42.2±1.1 mm up to 46.8±1.2 mm (p<0.05) 10 days postoperative. LVEDD, EF changed from preoperative 51.1±0.9 mm, 73±2% to 54.5±1.2 mm, 65±4% 10 days postoperative.
Conclusions. Threefold increase of ANP 10 days postoperative and return of TnT levels to normal under consideration of datas of echo show, that ANP is suitable to indicate the meanterm, functional, myocardial reduction. Increased ANP levels, atrial dilatation and dysfunction are important signs of cardial functional reduction after CAS.