Reversed remodelling in dilated cardiomyopathy by passive containment surgery is associated with decreased circulating levels of endothelin-1.
OBJECTIVE
To evaluate the influence on circulating levels of endothelin-1 and big endothelin-1 in relation to echocardiographic findings and functional assessment, by passive containment surgery in heart failure patients with dilated cardiomyopathy.


METHODS
Thirteen patients with dilated cardiomyopathy subjected to cardiac surgery received the Acorn Cardiac Support Device. Patients with ischemic dilated cardiomyopathy (n=6) underwent coronary artery bypass surgery receiving one to three bypass grafts. In the idiopathic dilated cardiomyopathy group (n=7), mitral valve plasty was performed in five patients while two patients received the cardiac support device only. Circulating plasma levels of endothelin-1 and big endothelin-1 were measured in all patients before surgery and 12 months after surgery. Concomitantly New York Heart Association functional class and 6-min walk were evaluated and cardiac dimensions measured with echocardiography.


RESULTS
Following surgery there was a significant decrease in circulating plasma levels of endothelin-1 (5.9+/-0.6 pM preoperatively vs 4.3+/-0.3 pM postoperatively, P<0.05). New York Heart Association functional class improved (2.8+/-0.2 preoperatively vs 1.8+/-0.2 postoperatively, P<0.05). The 6-min walk increased (384+/-24 m preoperatively vs 465+/-33 m postoperatively, P<0.05). There was also a decrease in left ventricular end diastolic diameter (69+/-2mm preoperatively vs 62+/-2mm postoperatively, P<0.05) and left ventricular end systolic diameter (60+/-2mm preoperatively vs 54+/-3mm postoperatively, P<0.05). Linear correlation revealed a relationship between decreased left ventricular end diastolic diameter and decreased endothelin-1 levels (R=0.56; P<0.05).


CONCLUSIONS
Following passive containment surgery using the Acorn Cardiac Support Device there is a decrease in circulating levels of endothelin-1 concomitant with a decrease in cardiac dimensions and function improvement.
Bredin
Fredrik
F
Department of Cardiothoracic Surgery and Anesthesiology, Karolinska University Hospital, S-171 76 Stockholm, Sweden. fredrik.bredin@karoloinska.se
Franco-Cereceda
Anders
A
D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D002311:Cardiomyopathy, Dilated / Q000097:blood / Q000188:drug therapy / Q000503:physiopathology / Q000601:surgery*; D002316:Cardiotonic Agents / Q000627:therapeutic use; D019332:Endothelin-1 / Q000097:blood*; D005260:Female; D005500:Follow-Up Studies; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome; D020257:Ventricular Remodeling; D016138:Walking
D015415:Biomarkers; D002316:Cardiotonic Agents; D019332:Endothelin-1