Blood levels of atrial natriuretic peptide, endothelin, cortisol and ACTH in patients undergoing coronary artery bypass grafting surgery with cardiopulmonary bypass
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Previous studies demonstrated a bi-phasic time course with post-operative dissociation of blood levels of cortisol and ACTH in patients undergoing major surgery and critically ill patients. A possible role of endothelin and atrial natriuretic peptide (ANP) in the dissociation of concentrations of cortisol and ACTH in critically ill patients has been suggested. In the present study, we investigated the perioperative course of blood levels of endothelin, ANP, ACTH, and cortisol in 13 male patients undergoing cardiac surgery with cardiopulmonary bypass (CPB): group 1 consisted of 7 patients with an uneventful perioperative period and group 2 consisted of 6 patients with perioperative complications. Blood samples were taken pre-[T1], intra-[T2], post-operatively (on the day of surgery) [T3], as well as on the first [T4] and second [T5] post-operative days. Blood samples of endothelin, ANP, cortisol, and ACTH were measured using commercially available immunoassays. Perioperatively, a biphasic time course with post-operative dissociation of ACTH and cortisol concentrations was observed in all patients studied. Intraoperatively, during CPB, the highest levels of endothelin were found. Perioperatively, ANP and endothelin levels were elevated compared to pre-operative values up to the second post-operative day. On the second post-operative day, ANP concentrations were significantly higher in patients with complications in the perioperative period compared to those with an uneventful perioperative period. Our results suggest that: 1) plasma levels of ANP increased in patients with perioperative complications; 2) plasma levels of ANP may have prognostic value for patients undergoing cardiac surgery; and 3) the dissociation of ACTH and cortisol cannot solely be explained by the increase in endothelin-1 and ANP concentrations observed in patients undergoing major surgery.
Key-wordsAtrial natriuretic peptide endothelin cortisol ACTH hemo-dilution cardiac surgery cardiopulmonary bypass HPA-axis
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- 5.Hinson J.P., Vinson G.P., Kapas S., Teja R. The role of endothelin in the control of adrenocortical function: stimulation of endothelin release by ACTH and the effects of endothelin-1 and endothelin-3 on steroidogenesis in rat and human adrenocortical cells. J. Endocrinol. 1991, 128: 275–280.PubMedCrossRefGoogle Scholar
- 9.Delarue C., Delton I., Fiorini F., Homo-Delarche F., Fasolo A., Braquet P., Vaudri H. Endothelin stimulates steroid secretion by frog adrenal gland in vitro: evidence for the involvement of prostaglandins and extracellular calcium in the mechanism of action of endothelin. Endocrinology 1990, 127: 2001–2008.PubMedCrossRefGoogle Scholar
- 10.Goetz K.L., Wang B.C., Madwed J.B., Zhu J.L., Leadley R.J. Cardiovascular, renal, and endocrine responses to intravenous endothelin in conscious dogs. Am. J. Physiol. Endocrinol. Metab. 1988, 255: R1064–R1068.Google Scholar
- 28.Geny B., Piquard F., Follenius M., Thiranos J.C., Charpentier A., Epailly E., Levy F., Kretz J.G., Eisenmann B., Haberey P. Endothelin participates in increased circulating atrial natriuretic peptide early after human heart transplantation. J. Heart Lung Transplant. 1998, 17: 167–175.PubMedGoogle Scholar
- 30.Roth-Isigkeit A., v. Borstel T., Seyfarth M., Schmucker P. Perioperative serum levels of tumour-necrosis-factor alpha (TNF-α), IL-1β, IL-6, IL-10 and soluble IL-2 receptor in patients undergoing cardiac surgery with cardiopulmonary bypass without and with correction for haemodilution. Clin. Exp. Immunol. 1999, 118: 242–246.PubMedCentralPubMedCrossRefGoogle Scholar
- 31.Hasdai D., Erez E., Gil-Ad I., Raanani E., Sclarovsky S., Barak Y., Sulkes J., Vidne B.A. Is the heart a source for elevated circulating endothelin levels during aorta-coronary artery bypass grafting surgery in human beings? J. Thorac. Cardiovasc. Surg. 1996, 112: 531–536.PubMedCrossRefGoogle Scholar
- 32.Haak T., Matheis G., Kohleisen M., Ngo H., Beyersdorf F., Usadel K.H. Endothelin during cardiovascular surgery: the effect of diltiazem and nitroglycerin. J. Cardiovasc. Pharmacol. 1995, 26 (Suppl. 3): 5494–5496.Google Scholar
- 42.Hall C., Rouleau J.L., Moye L., de Champlain J., Bichet D., Klein M., Sussex B., Packer M., Rouleau J., Arnold M.O., Lamas G.A., Sestier F., Gottlieb S.S. Wun C.C., Pfeffer M.A. N-terminal proatrial natriuretic factor. An independent predictor of long-term prognosis after myocardial infarction. Circulation 1994, 89: 1934–1942.PubMedCrossRefGoogle Scholar
- 43.De Groote P., Millaire A., Pigny P., Nugue O., Racadot A., Ducloux G. Plasma levels of atrial natriuretic peptide at peak exercise: a prognostic marker of cardiovascular-related death and heart transplantation in patients with moderate congestive heart failure. J. Heart Lung Transpl. 1997, 16: 956–963.Google Scholar
- 47.Ambrosi B., Sala C., Bochicchio D., Colombo P., Gazzano G., Fadin C., Morganti A., Faglia G. Effect of atrial natriuretic factor infusion on basal and CRH-stimulated ACTH, cortisol and aldosterone levels in patients with Cushing’s or Addison’s disease. Clin. Endocrinol. (Oxf.) 1994, 40: 589–594.CrossRefGoogle Scholar
- 48.Kellner M., Herzog L., Holsboer F., Wiedemann K. Circadian changes in the sensitivity of the corticotropin-releasing hormone-stimulated HPA system after arginine vasopressin and atrial natriuretic hormone in human male controls. Psychoneuroendocrinology 1995, 20: 515–524.PubMedCrossRefGoogle Scholar