缺血性心肌病患者左心室重建手术的神经激素反应

Neurohormonal response to left ventricular reconstruction surgery in ischemic cardiomyopathy.

作者信息

Schenk Soren, McCarthy Patrick M, Starling Randall C, Hoercher Katherine J, Hail Melanie D, Ootaki Yoshio, Francis Gary S, Doi Kazuyoshi, Young James B, Fukamachi Kiyotaka

机构信息

Department of Biomedical Engineering, Lerner Research Institute, The Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.

出版信息

J Thorac Cardiovasc Surg. 2004 Jul;128(1):38-43. doi: 10.1016/j.jtcvs.2003.11.012.

DOI:10.1016/j.jtcvs.2003.11.012

PMID:15224019

Abstract

OBJECTIVES

Activation of the neuroendocrine axis in congestive heart failure is of prognostic significance, and neurohumoral blocking therapy prolongs survival. The hypothesis that surgical reduction of left ventricular size and function decreases neuroendocrine activation is less established. We evaluated the neurohormonal response to left ventricular reconstruction surgery in ischemic cardiomyopathy.

METHODS

Norepinephrine, plasma renin activity, and angiotensin II were measured in 10 patients before and 12 months after left ventricular reconstruction. In an additional 5 patients, brain natriuretric peptide was measured before and 3 months postoperatively. Three-dimensional cardiovascular imaging was used to assess ejection fraction and left ventricular end-diastolic volume index.

RESULTS

Concurrent with improvements of New York Heart Association functional class (2.9 +/- 0.5 preoperatively vs 2.0 +/- 0.4 postoperatively, P <.001), ejection fraction (23.9% +/- 6.6% vs 36.2% +/- 6.2%, P <.01), and left ventricular end-diastolic volume index (140.8 +/- 33.8 mL/m(2) vs 90.6 +/- 18.3 mL/m(2), P <.01), considerable reductions were observed for median plasma profiles of norepinephrine (562.0 pg/mL vs 319.0 pg/mL, P <.05), plasma renin activity (5.75 microg/L/h vs 3.45 microg/L/h, P <.05), angiotensin II (41.0 ng/mL vs 23.0 ng/mL, P =.051), and brain natriuretric peptide (771.0 pg/mL vs 266.0 pg/mL, P <.05). The more plasma renin activity or angiotensin II decreased after left ventricular reconstruction, the higher was the increase in ejection fraction (R = -.745, P <.05 [plasma renin activity]; R = -.808, P <.05 [angiotensin II]).

CONCLUSIONS

Surgical improvements of ejection fraction and left ventricular end-diastolic volume index by left ventricular reconstruction were accompanied by improvement of both the neuroendocrine activity and the functional status in patients with congestive heart failure. Whether this favorable neurohormonal response is predictive of an improved survival requires further evaluation.

摘要

目的

充血性心力衰竭时神经内分泌轴的激活具有预后意义，神经体液阻断治疗可延长生存期。左心室大小和功能的手术性降低会减少神经内分泌激活这一假说尚未得到充分证实。我们评估了缺血性心肌病患者左心室重建手术的神经激素反应。

方法

对10例患者在左心室重建术前及术后12个月测量去甲肾上腺素、血浆肾素活性和血管紧张素II。另外5例患者在术前及术后3个月测量脑钠肽。采用三维心血管成像评估射血分数和左心室舒张末期容积指数。

结果

与纽约心脏协会功能分级改善（术前2.9±0.5 vs术后2.0±0.4，P<.001）、射血分数（23.9%±6.6% vs 36.2%±6.2%，P<.01）和左心室舒张末期容积指数（140.8±33.8 mL/m² vs 90.6±18.3 mL/m²，P<.01）同时，去甲肾上腺素的血浆中位数水平（562.0 pg/mL vs 319.0 pg/mL，P<.05）、血浆肾素活性（5.75 μg/L/h vs 3.45 μg/L/h，P<.05）、血管紧张素II（41.0 ng/mL vs 23.0 ng/mL，P=.051）和脑钠肽（771.0 pg/mL vs 266.0 pg/mL，P<.05）均有显著降低。左心室重建后血浆肾素活性或血管紧张素II降低越多，射血分数增加越高（R = -.745，P<.05[血浆肾素活性]；R = -.808，P<.05[血管紧张素II]）。