扩张型心肌病患者通过被动包裹手术实现的逆向重构与循环中内皮素-1水平降低有关。

Reversed remodelling in dilated cardiomyopathy by passive containment surgery is associated with decreased circulating levels of endothelin-1.

作者信息

Bredin Fredrik, Franco-Cereceda Anders

机构信息

Department of Cardiothoracic Surgery and Anesthesiology, Karolinska University Hospital, S-171 76 Stockholm, Sweden.

出版信息

Eur J Cardiothorac Surg. 2006 Mar;29(3):299-303. doi: 10.1016/j.ejcts.2005.12.011. Epub 2006 Jan 26.

DOI:10.1016/j.ejcts.2005.12.011

PMID:16442807

Abstract

OBJECTIVE

To evaluate the influence on circulating levels of endothelin-1 and big endothelin-1 in relation to echocardiographic findings and functional assessment, by passive containment surgery in heart failure patients with dilated cardiomyopathy.

METHODS

Thirteen patients with dilated cardiomyopathy subjected to cardiac surgery received the Acorn Cardiac Support Device. Patients with ischemic dilated cardiomyopathy (n=6) underwent coronary artery bypass surgery receiving one to three bypass grafts. In the idiopathic dilated cardiomyopathy group (n=7), mitral valve plasty was performed in five patients while two patients received the cardiac support device only. Circulating plasma levels of endothelin-1 and big endothelin-1 were measured in all patients before surgery and 12 months after surgery. Concomitantly New York Heart Association functional class and 6-min walk were evaluated and cardiac dimensions measured with echocardiography.

RESULTS

Following surgery there was a significant decrease in circulating plasma levels of endothelin-1 (5.9+/-0.6 pM preoperatively vs 4.3+/-0.3 pM postoperatively, P<0.05). New York Heart Association functional class improved (2.8+/-0.2 preoperatively vs 1.8+/-0.2 postoperatively, P<0.05). The 6-min walk increased (384+/-24 m preoperatively vs 465+/-33 m postoperatively, P<0.05). There was also a decrease in left ventricular end diastolic diameter (69+/-2mm preoperatively vs 62+/-2mm postoperatively, P<0.05) and left ventricular end systolic diameter (60+/-2mm preoperatively vs 54+/-3mm postoperatively, P<0.05). Linear correlation revealed a relationship between decreased left ventricular end diastolic diameter and decreased endothelin-1 levels (R=0.56; P<0.05).

CONCLUSIONS

Following passive containment surgery using the Acorn Cardiac Support Device there is a decrease in circulating levels of endothelin-1 concomitant with a decrease in cardiac dimensions and function improvement.

摘要

目的

通过对扩张型心肌病心力衰竭患者进行被动包裹手术，评估其对内皮素-1和大内皮素-1循环水平的影响，并与超声心动图检查结果及功能评估相关联。

方法

13例接受心脏手术的扩张型心肌病患者植入了橡果心脏支持装置。6例缺血性扩张型心肌病患者接受了冠状动脉搭桥手术，搭桥数量为1至3根。在特发性扩张型心肌病组（n = 7）中，5例患者进行了二尖瓣成形术，2例患者仅接受了心脏支持装置。在所有患者手术前及术后12个月测量内皮素-1和大内皮素-1的循环血浆水平。同时评估纽约心脏协会心功能分级和6分钟步行距离，并通过超声心动图测量心脏大小。

结果

手术后，内皮素-1的循环血浆水平显著降低（术前5.9±0.6 pM，术后4.3±0.3 pM，P<0.05）。纽约心脏协会心功能分级改善（术前2.8±0.2，术后1.8±0.2，P<0.05）。6分钟步行距离增加（术前384±24 m，术后465±33 m，P<0.05）。左心室舒张末期内径也减小（术前69±2mm，术后62±2mm，P<0.05），左心室收缩末期内径减小（术前60±2mm，术后54±3mm，P<0.05）。线性相关性显示左心室舒张末期内径减小与内皮素-1水平降低之间存在关联（R = 0.56；P<0.05）。