Effect of acute brain death on release of atrium and B-type natriuretic peptides in an animal model.
BACKGROUND
Atrium and B-type natriuretic peptides (ANP and BNP) and big endothelin (ET)-1 are markers for severity of heart failure and may be used in the quality assessment of donor hearts. Elevated cardiac troponins predict early graft failure after heart transplantation. This study evaluated the effects of acute brain death (BD) on the release of ANP, BNP, big ET-1, and cardiac troponins in an animal model.


METHODS
Pigs were randomized into a BD group (n=5) and a control group (n=5). In the first group, acute BD was induced, and anesthesia was stopped. In the control animals, a sham operation was performed, and anesthesia was continued. Parameters were measured at baseline and for 13 hours postoperatively.


RESULTS
After acute BD, there were significant hemodynamic changes. In the control group, the BNP level was higher than in the BD group and decreased over time (P =0.016). There was no significant change in BNP release in the BD group up to 13 hours (P =0.1). ANP release remained stable over time in the control group (P =0.35) but decreased in the BD group (P =0.043). The big ET-1 levels were not different between groups. Cardiac troponin I was elevated in the BD group 5 hours after BD (P< 0.05) but remained under 1.5 mg/L throughout the study.


CONCLUSIONS
Acute BD did not lead to an increase of BNP and ANP levels. Moreover, intact brain function seems to augment the release of natriuretic peptides from the myocardium. Further clinical evaluation of prognostic values of natriuretic peptides for the assessment of donor hearts is necessary. Cardiac troponins are a useful additional tool in the evaluation of donor hearts.
Potapov
E V
EV
Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum, Berlin, Germany. potapov@dhzb.de
Blömer
T
T
Michael
R
R
Hennig
F
F
Müller
C
C
Loebe
M
M
Skrabal
C
C
Hetzer
R
R
D000208:Acute Disease; D000818:Animals; D009320:Atrial Natriuretic Factor / Q000378:metabolism*; D001926:Brain Death / Q000378:metabolism*; D019332:Endothelin-1 / Q000378:metabolism; D005260:Female; D008297:Male; D023421:Models, Animal; D020097:Natriuretic Peptide, Brain / Q000378:metabolism*; D013552:Swine; D019210:Troponin I / Q000378:metabolism
D019332:Endothelin-1; D019210:Troponin I; D020097:Natriuretic Peptide, Brain; D009320:Atrial Natriuretic Factor