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THE JOURNAL OF CARDIOVASCULAR SURGERY

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The Journal of Cardiovascular Surgery 2002 October;43(5):595-601

lingua: Inglese

Perioperative levels of atrial natriuretic peptid and Troponin-T in patients with uncomplicated coronary artery surgery

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


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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.

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