Reversed remodelling in dilated cardiomyopathy by passive containment surgery is associated with decreased circulating levels of endothelin-1

Bredin, Fredrik; Franco-Cereceda, Anders
March 2006
European Journal of Cardio-Thoracic Surgery;Mar2006, Vol. 29 Issue 3, p299
Academic Journal
Abstract: 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±0.6pM preoperatively vs 4.3±0.3pM 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±24m preoperatively vs 465±33m 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.


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