Neurohormonal response to left ventricular reconstruction surgery in ischemic cardiomyopathy

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

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

51 Scopus citations

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/m2 vs 90.6 ± 18.3 mL/m2, 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 μg/L/h vs 3.45 μg/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.

Original languageEnglish (US)
Pages (from-to)38-43
Number of pages6
JournalJournal of Thoracic and Cardiovascular Surgery
Volume128
Issue number1
DOIs
StatePublished - Jul 2004

Keywords

  • 22
  • 23
  • 30

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Fingerprint Dive into the research topics of 'Neurohormonal response to left ventricular reconstruction surgery in ischemic cardiomyopathy'. Together they form a unique fingerprint.

Cite this