Enalaprilat decreases plasma endothelin and atrial natriuretic peptide levels and preload in patients with left ventricular dysfunction after cardiac surgery

Tohmo, H.; Karanko, Meri S.; Klossner, J; Scheinin, Mika; Viinamäki, O; Neuvonen, Pertti J.; Ruskoaho, Heikki

doi:10.1016/s1053-0770(97)90009-4

Cited by 8 publications

(5 citation statements)

References 35 publications

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“…Just before CPB, ACEI-treated patients had a lower systemic vascular resistance than controls (by 32%) and an increased CI (by 26%); these effects were maintained after CPB and during the ®rst 2 days after surgery. Such an improvement in cardiac output after acute ACEI treatment in patients with cardiac failure has been observed at rest 21 and during episodes of cardiac failure occurring during 22 or after 23 cardiac surgery. The haemodynamic effect was sustained for the period of ACEI treatment, a fact established several years ago.…”

Section: Discussionmentioning

confidence: 84%

Haemodynamic and renal effects of intravenous enalaprilat during coronary artery bypass graft surgery in patients with ischaemic heart dysfunction †

Ryckwaert

Colson

Ribstein

et al. 2001

British Journal of Anaesthesia

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Renal dysfunction occurring after open heart surgery is multifactorial in origin but activation of the renin-angiotensin system may have a prominent role. Fourteen patients with ischaemic heart dysfunction scheduled for elective coronary artery bypass graft (CABG) surgery were allocated to a treatment group [enalaprilat for 2 days; ACEI (angiotensin-converting enzyme inhibitor) group, n=7] or a control group (n=7). The cardiac index was significantly higher in ACEI-treated patients than in the controls before and after cardiopulmonary bypass (CPB) (P<0.05) and on postoperative day 2 (P<0.05). The systemic vascular resistance was significantly lower in the ACEI-treated patients than in the controls before and after CPB (P<0.05). Renal plasma flow, measured as [131I]orthoiodohippuran clearance (ClH), was higher in the ACEI group than in the control group before CPB, as was endogenous creatinine clearance after CPB (P<0.05). On post-operative day 7, ClH was significantly higher in the ACEI group than in the control group (P<0.05). Plasma renin activity and vasopressin concentration increased in both groups during CPB (P<0.05). The study demonstrates that administration of an i.v. ACEI, enalaprilat, improves cardiac output during CABG surgery in patients with ischaemic heart dysfunction. Moreover, renal perfusion was better maintained during surgery, and this effect was sustained up to post-operative day 7.

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Section: Discussionmentioning

confidence: 84%

Haemodynamic and renal effects of intravenous enalaprilat during coronary artery bypass graft surgery in patients with ischaemic heart dysfunction †

Ryckwaert

Colson

Ribstein

et al. 2001

British Journal of Anaesthesia

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“…The interaction of the covariate with the variables themselves is highly significant (p Ͻ .001), and there are also significant interactions between the covariate and the time effect for Ḋ O 2 I (p ϭ .013) and V O 2 I (p ϭ .014). constrictor activity (9,10,12,23).…”

Section: Discussionmentioning

confidence: 99%

“…ACE inhibitors usually are discontinued during this postoperative phase to avoid symptomatic hypotension, deleterious effects on renal function, and an electrolyte imbalance. So far, only one small uncontrolled study (9) has been published on the use of ACE inhibitors in the treatment of left ventricular dysfunction after cardiac surgery.…”

mentioning

confidence: 99%

Beneficial hemodynamic and renal effects of intravenous enalaprilat following coronary artery bypass surgery complicated by left ventricular dysfunction*

Wagner

Yeter

Bisson

et al. 2003

Critical Care Medicine

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“…Mehrere international veröffentlichte Studien beschäftigen sich mit der Rolle des ANPs im Zusammenhang mit ischämischen Ereignissen am Myokard und der Frage, ob die Konzentrationsverläufe dieses Hormons zur Einschätzung der kardialen Funktion herangezogen werden können (1,5,7,19,21,22,27,28). Auch die Rolle des TnTs in der Bypasschirurgie zur Abschätzung des myokardialen Schadens und als Verlaufsmarker für die Beeinträchtigung der Funktion des linken Ventrikels und des oxidativen Metabolismus wurden mehrfach untersucht (12,13,25).…”

Section: Diskussionunclassified

Das atriale natriuretische Peptid als Indikator einer milden postoperativen kardialen Dysfunktion nach unkomplizierter Bypasschirurgie

Langenbach¹,

Korbmacher

Schulte

et al. 2000

Z Kardiol

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Plasma levels of ANP (pg/ml; radioimmunoassay) as a parameter for postischemic dysfunction and levels of Troponin T (TnT) (ng/ml; ELISA test) as a parameter for postischemic cellular damage were determined in 15 patients with coronary artery disease (CAD) (mean age: 58 +/- 6.1 years; 13 m, 2 w; with no history of myocardial infarction and no signs for congestive heart failure) prior to, during and after extracorporal circulation (ECC). Under standardized conditions during the ECC basic parameters concerning the cardial hemodynamic (heart rate (HR); systolic (RRsys, mmHg), diastolic pressure (RR dia, mmHg) central venous pressure (CVP, mmHg); left atrial pressure (LAP, mmHg); left ventricular enddiastolic pressure (LVEDP, mmHg)) and ECG monitoring blood samples were performed: 1) prior to operation (op); 2) prior to CPB; 3) 1 h CPB; 4) 5 min after CPB; 5) 1 h after CPB; 6) 6 h postoperative (postop); 7) 24 h postop; 8) 48 h postop; 9) 10 days postop. Also the left atrial diameter (LAD, mm) and the left ventricular enddiastolic diameter at Q (LVEDD, mm) pre- and postop were documented with m-mode echocardiography (Echo) and ejection fraction (EF, %) was calculated. The bypass operations were performed with intermittent aortic cross-clamping with open venae cavae (CVP: 0-5 mmHg) and moderate hypothermia. For the determination of ANP levels and TnT levels in arterial and venous blood, a double-antibody (AB) radioimmunoassay and an ELISA test were used. Concerning the patients with CAD there was a maximal increase of ANP from preoperative 90 +/- 10 (M +/- SEM) pg/ml (p < 0.05) up to intraoperative 380 +/- 38 pg/ml. Ten days postop, the ANP level was with 262 +/- 33 pg/ml still increased threefold in comparison to the preoperative level. TnT showed an increase from preoperative 0.02 +/- 0.01 ng/ml up to intraoperative 3.44 +/- 0.47 ng/ml. Ten days postop the TnT concentration was at the preoperative level with 0.13 +/- 0.11 ng/ml. Five minutes after bypass up to 48 h postop, ANP and TnT levels were correlated (p < 0.05, r = 3.4). There was an increase of the LAD from preoperative 42.2 +/- 1.1 mm up to 46.8 +/- 1.2 mm (p < 0.05) 10 days postop as determined by m-mode echo. LVEDD and EF changed from preoperative 51.1 +/- 0.9 mm and 73 +/- 2% to 54.5 +/- 1.2 mm and 65 +/- 4% 10 days postop. The significant increase of TnT (172-fold) indicates the cellular, myocardial injury, caused by the operation without signs in ECG recordings and no signs of congestive heart failure. The significantly increased ANP level up to the 10th day postop indicate sa very sensitive prolonged, postischemic dysfunction, which is not compensated 10 days postop.

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Enalaprilat decreases plasma endothelin and atrial natriuretic peptide levels and preload in patients with left ventricular dysfunction after cardiac surgery

Cited by 8 publications

References 35 publications

Haemodynamic and renal effects of intravenous enalaprilat during coronary artery bypass graft surgery in patients with ischaemic heart dysfunction †

Haemodynamic and renal effects of intravenous enalaprilat during coronary artery bypass graft surgery in patients with ischaemic heart dysfunction †

Beneficial hemodynamic and renal effects of intravenous enalaprilat following coronary artery bypass surgery complicated by left ventricular dysfunction*

Das atriale natriuretische Peptid als Indikator einer milden postoperativen kardialen Dysfunktion nach unkomplizierter Bypasschirurgie

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