ORIGINAL ARTICLES  CARDIAC SECTION 

The Journal of Cardiovascular Surgery 2008 December;49(6):783-91

Copyright © 2008 EDIZIONI MINERVA MEDICA

lingua: Inglese

Changes in natriuretic peptides, apelin and adrenomedullin after off-pump and on-pump coronary artery bypass surgery

Mahar M. A. A. ¹, Rainio A. ¹, Ilves M. ², Lindgren K. ¹, Kärjä-Koskenkari P. ¹, Taskinen P. ¹, Vuolteenaho O. ², Biancari F. ¹

¹ Division of Cardiothoracic and Vascular Surgery Department of Surgery University of Oulu, Oulu, Finland 2 Department of Physiology University of Oulu, Oulu, Finland

Aim. The authors have evaluated the postoperative changes of natriuretic peptides, apelin and adrenomedullin after off-pump (OPCAB) and on-pump coronary artery bypass surgery (CCAB) to assess the impact of these techniques on the myocardium.
Methods. Twenty-two patients underwent OPCAB and 24 patients underwent CCAB. Plasma levels of NT-proANP, NT-proBNP, apelin and adrenomedullin were measured preoperatively, and on the 1st, 3rd, and 5th postoperative day.
Results. Natriuretic peptides, apelin and adrenomedullin increased significantly postoperatively. Natriuretic peptides were markedly elevated on the fifth postoperative day. Apelin was still increasing, but adrenomedullin, although elevated, clearly decreased toward baseline levels on the fifth postoperative day. CCAB was associated with significantly higher postoperative cTnI, but levels of natriuretic peptides, adrenomedullin and apelin did not differ significantly after CCAB and OPCAB. cTnI, echocardiographic parameters, cardiac index, and degree of postoperative pericardial effusion did not correlate with levels of natriuretic peptides, apelin and adrenomedullin. Postope-rative levels of natriuretic peptides were significantly associated with parameters of renal function, age, and extracardiac arteriopathy. The correlation between preoperative estimated glomerular filtration rate and natriuretic peptides increased along the study intervals (NT-proANP rho: -0.181, -0.350, -0.364, and -0.442; NT-proBNP rho: -0.112, -0.420, -0.405 and -0.550). Also adrenomedullin correlated with parameters of renal function. The postoperative levels of apelin were not associated with any variable.
Conclusion. A marked, sustained and similar increase in these five markers of cardiac adaptation was detected after OPCAB and CCAB. The upregulation of these peptides should be further investigated to evaluate their potential beneficial/harmful impact on the outcome after coronary surgery.