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Neurohormonal response to left ventricular reconstruction surgery in ischemic cardiomyopathy.
J Thorac Cardiovasc Surg. 2004 Jul; 128(1):38-43.JT

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.

Authors+Show Affiliations

Department of Biomedical Engineering, Lerner Research Institute, The Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

15224019

Citation

Schenk, Soren, et al. "Neurohormonal Response to Left Ventricular Reconstruction Surgery in Ischemic Cardiomyopathy." The Journal of Thoracic and Cardiovascular Surgery, vol. 128, no. 1, 2004, pp. 38-43.
Schenk S, McCarthy PM, Starling RC, et al. Neurohormonal response to left ventricular reconstruction surgery in ischemic cardiomyopathy. J Thorac Cardiovasc Surg. 2004;128(1):38-43.
Schenk, S., McCarthy, P. M., Starling, R. C., Hoercher, K. J., Hail, M. D., Ootaki, Y., Francis, G. S., Doi, K., Young, J. B., & Fukamachi, K. (2004). Neurohormonal response to left ventricular reconstruction surgery in ischemic cardiomyopathy. The Journal of Thoracic and Cardiovascular Surgery, 128(1), 38-43.
Schenk S, et al. Neurohormonal Response to Left Ventricular Reconstruction Surgery in Ischemic Cardiomyopathy. J Thorac Cardiovasc Surg. 2004;128(1):38-43. PubMed PMID: 15224019.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Neurohormonal response to left ventricular reconstruction surgery in ischemic cardiomyopathy. AU - Schenk,Soren, AU - McCarthy,Patrick M, AU - Starling,Randall C, AU - Hoercher,Katherine J, AU - Hail,Melanie D, AU - Ootaki,Yoshio, AU - Francis,Gary S, AU - Doi,Kazuyoshi, AU - Young,James B, AU - Fukamachi,Kiyotaka, PY - 2004/6/30/pubmed PY - 2004/8/13/medline PY - 2004/6/30/entrez SP - 38 EP - 43 JF - The Journal of thoracic and cardiovascular surgery JO - J Thorac Cardiovasc Surg VL - 128 IS - 1 N2 - 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. SN - 0022-5223 UR - https://www.unboundmedicine.com/medline/citation/15224019/Neurohormonal_response_to_left_ventricular_reconstruction_surgery_in_ischemic_cardiomyopathy_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0022522303019123 DB - PRIME DP - Unbound Medicine ER -