title: Effects of thoracic epidural analgesia on plasma cAMP and cGMP levels in patients with heart failure.
abstract: OBJECTIVE
  The progression of heart failure is affected by several factors, including chronic stimulation of the β-adrenoceptor. This clinical study was designed to measure the effects of thoracic epidural analgesia (TEA) on the plasma levels of norepinephrine (NE), cAMP, and cGMP in patients with heart failure and assess the clinical implication of TEA.
  
  
  METHODS
  Forty patients with heart failure were randomly assigned to TEA (TEA plus standard care) and control groups (standard care). The plasma concentrations of cAMP, cGMP, brain natriuretic peptide (BNP), and NE were measured using ELISA before treatment, the second and fourth weeks of treatment.
  
  
  RESULTS
  The plasma concentrations of cAMP, cGMP, BNP, and NE in the TEA group were significantly reduced by the fourth week compared to their initial concentrations (P < 0.01, for all parameters) and the control group (P < 0.05, P < 0.05, P < 0.01, and P < 0.05, respectively). The values for left ventricular end diastolic diameter (LVEDD), ejection fraction (EF), and fractional shortening (FS) in the TEA group improved significantly compared to their initial values and the control group. However, the changes in levels for these indices in the control group were no statistical significant compared to the initial levels.
  
  
  CONCLUSIONS
  TEA can effectively decrease the plasma concentrations of cAMP and cGMP and improve cardiac function in patients with heart failure. The decreased levels of NE and cAMP occurred before the improvement in cardiac function, indicating that the abnormal epidural signal transduction can be corrected in patients with heart failure.
authors.affiliation: Department of Cardiology, First Affiliated Hospital of Harbin Medical University, Harbin 150001, China. liqingshu1985@126.com.
authors.forename: Qing-Shu
authors.initials: QS
authors.lastname: Li
authors.forename: Feng-Qi
authors.initials: FQ
authors.lastname: Liu
mesh_terms: D015360:Analgesia, Epidural / Q000379:methods*; D000242:Cyclic AMP / Q000097:blood*; D006152:Cyclic GMP / Q000097:blood*; D005260:Female; D006333:Heart Failure / Q000097:blood* / Q000000981:diagnostic imaging / Q000628:therapy*; D006801:Humans; D008297:Male; D009638:Norepinephrine / Q000097:blood; D015398:Signal Transduction; D013904:Thoracic Vertebrae; D016896:Treatment Outcome; D014463:Ultrasonography
chemical_list: D000242:Cyclic AMP; D006152:Cyclic GMP; D009638:Norepinephrine