title: Vascular response to angiotensin II predicts long-term prognosis in patients undergoing coronary artery bypass grafting.
abstract: Persistent activation of the renin-angiotensin system leads to downregulation of the angiotensin type-1 receptor, and consequently, to a decreased response to exogenous angiotensin II. In the present study, we investigated the association of angiotensin II responsiveness to clinical outcome after coronary artery bypass grafting (CABG). We studied the responsiveness to exogenous angiotensin II in human thoracic artery preparations of 114 CABG patients. Mean duration of follow-up was 7.3+/-0.1 years, during which 21 patients experienced a cardiovascular event. A diminished response to angiotensin II remained in multivariate Cox regression analysis, after adjustment for sex, age, blood pressure, and number of diseased coronary arteries, the strongest predictor for cardiovascular events (relative risk, 3.37 [95% confidence interval, 1.20 to 9.51]; P=0.022). Furthermore, diminished response to angiotensin II was associated with an increased mean arterial pressure (102.85+/-1.38 versus 97.40+/-1.37; P=0.003) and a nonsignificant increase in angiotensin-converting enzyme activity, suggestive for a persistently activated renin-angiotensin system. In conclusion, these results suggest that in patients undergoing CABG, a diminished vascular responsiveness of the thoracic artery to exogenous angiotensin II is related to an increased risk of future cardiovascular events.
authors.affiliation: Department of Cardiology, University Hospital Groningen, The Netherlands.
authors.forename: Pim
authors.initials: P
authors.lastname: van der Harst
authors.forename: Meint
authors.initials: M
authors.lastname: Volbeda
authors.forename: Adriaan A
authors.initials: AA
authors.lastname: Voors
authors.forename: Hendrik
authors.initials: H
authors.lastname: Buikema
authors.forename: Sven
authors.initials: S
authors.lastname: Wassmann
authors.forename: Michael
authors.initials: M
authors.lastname: Böhm
authors.forename: Georg
authors.initials: G
authors.lastname: Nickenig
authors.forename: Wiek H
authors.initials: WH
authors.lastname: van Gilst
mesh_terms: D000368:Aged; D000804:Angiotensin II / Q000494:pharmacology*; D001794:Blood Pressure; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000503:physiopathology / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D066298:In Vitro Techniques; D008297:Male; D008875:Middle Aged; D007703:Peptidyl-Dipeptidase A / Q000378:metabolism*; D011379:Prognosis; D016016:Proportional Hazards Models; D012084:Renin-Angiotensin System / Q000502:physiology*; D012307:Risk Factors; D016019:Survival Analysis; D013895:Thoracic Arteries / Q000187:drug effects*; D014662:Vasoconstrictor Agents / Q000494:pharmacology*
chemical_list: D014662:Vasoconstrictor Agents; D000804:Angiotensin II; D007703:Peptidyl-Dipeptidase A