Patients with poor preoperative ejection fraction have a higher plasma response of adrenomedullin in response to open heart surgery.
BACKGROUND
Adrenomedullin (AM) is a potent vasodilator peptide. Plasma AM levels are increased in heart diseases and in sepsis. Heart surgery under cardiopulmonary bypass (CPB) induces a systemic inflammatory response.


METHODS
We measured plasma AM, cAMP (the second messenger of AM), C-reactive protein (CRP) and haemodynamic parameters in 29 patients undergoing elective open heart surgery, before, during and after anaesthesia and CPB as well as on the first morning after surgery.


RESULTS
Basal AM levels were higher than normal and correlated with systolic pulmonary pressure and pulmonary capillary pressure, but not with other haemodynamic parameters. AM increased during CPB and remained elevated 24 h after the start of surgery. Plasma cAMP increased only at the end of CPB. CRP was increased only in the last sample. At the end of CPB and at the end of surgery AM levels were higher in patients with basal ejection fraction<40% compared with those with ejection fraction >60% [456+/-386 vs 252+/-343 (P<0.03) and 832+/-781 vs 391+/-356 pg/ml (P<0.05), respectively].


CONCLUSIONS
We conclude that AM, as inflammation-related cytokines, increases during and after CPB, that cAMP response is unrelated to AM and that AM response is higher in those patients with worse basal ejection fraction.
Amado
J A
JA
Endocrine Service, Hospital Universitario Marqués de Valdecilla, University of Cantabria, Santander, Spain.
Fidalgo
I
I
García-Unzueta
M T
MT
Montalbán
C
C
Del Moral
I
I
Pazos
F
F
Diago
C
C
D053607:Adrenomedullin; D000768:Anesthesia, General; D001794:Blood Pressure / Q000502:physiology; D002097:C-Reactive Protein / Q000032:analysis; D015740:Calcitonin Gene-Related Peptide / Q000097:blood*; D002302:Cardiac Output / Q000502:physiology; D002303:Cardiac Output, Low / Q000097:blood / Q000503:physiopathology; D006348:Cardiac Surgical Procedures / Q000009:adverse effects; D002315:Cardiopulmonary Bypass / Q000009:adverse effects; D002496:Central Venous Pressure / Q000502:physiology; D000242:Cyclic AMP / Q000097:blood; D017558:Elective Surgical Procedures; D005260:Female; D006331:Heart Diseases / Q000097:blood / Q000503:physiopathology / Q000601:surgery; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010455:Peptides / Q000097:blood*; D011651:Pulmonary Artery; D011669:Pulmonary Wedge Pressure / Q000502:physiology; D015290:Second Messenger Systems; D013318:Stroke Volume / Q000502:physiology*; D018746:Systemic Inflammatory Response Syndrome / Q000097:blood / Q000209:etiology; D014655:Vascular Resistance / Q000502:physiology; D014665:Vasodilator Agents / Q000097:blood*
D010455:Peptides; D014665:Vasodilator Agents; D053607:Adrenomedullin; D002097:C-Reactive Protein; D000242:Cyclic AMP; D015740:Calcitonin Gene-Related Peptide