Adrenomedullin in patients at high risk for pulmonary hypertension

Palaniswamy Vijay, Laszlo Szekely, Thomas G. Sharp, Andrew Miller, Ko Bando, John Brown

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Background. Adrenomedullin is a newly identified peptide with profound hypotensive effects. We investigated perioperative adrenomedullin levels among patients with congenital heart disease with and without pulmonary hypertension. Methods. Levels of plasma adrenomedullin, endothelin-1, and nitric oxide metabolites were measured in three groups: (1) low pulmonary flow (n = 11); (2) high flow/low pulmonary arterial pressure (less than 60% systemic pressure) (n = 9); and (3) high flow/high pressure (n = 10). Samples were obtained preoperatively, on and off pump, and 3, 6, and 12 hours after bypass. Results. Adrenomedullin levels were highest in the low pulmonary flow group (189.7 ± 15 pg/mL low flow versus 103.1 ± 9.5 pg/mL high flow/low pulmonary and 139 ± 17.5 pg/mL high flow/high pressure at 12 hours; p ≤ 0.05). The arterial pressure/systemic pressure remained significantly lower in the high flow/low pulmonary pressure compared with the high flow/high pressure group (0.37 ± 0.08 versus 0.62 ± 0.11; p < 0.005). Perioperative endothelin-1 and nitric oxide levels remained low in the low pulmonary flow group but increased progressively in both high flow groups. Conclusions. Circulating plasma adrenomedullin appears to affect baseline vascular tone in patients with intact endothelial function. It may interact with nitric oxide and endothelin-1 to help regulate blood pressure perioperatively in patients with congenital heart disease.

Original languageEnglish
Pages (from-to)500-505
Number of pages6
JournalAnnals of Thoracic Surgery
Volume66
Issue number2
DOIs
StatePublished - Aug 1998

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Adrenomedullin
Pulmonary Hypertension
Pressure
Lung
Endothelin-1
Nitric Oxide
Heart Diseases
Arterial Pressure
Blood Vessels
Blood Pressure
Peptides

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Adrenomedullin in patients at high risk for pulmonary hypertension. / Vijay, Palaniswamy; Szekely, Laszlo; Sharp, Thomas G.; Miller, Andrew; Bando, Ko; Brown, John.

In: Annals of Thoracic Surgery, Vol. 66, No. 2, 08.1998, p. 500-505.

Research output: Contribution to journalArticle

Vijay, Palaniswamy ; Szekely, Laszlo ; Sharp, Thomas G. ; Miller, Andrew ; Bando, Ko ; Brown, John. / Adrenomedullin in patients at high risk for pulmonary hypertension. In: Annals of Thoracic Surgery. 1998 ; Vol. 66, No. 2. pp. 500-505.
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N2 - Background. Adrenomedullin is a newly identified peptide with profound hypotensive effects. We investigated perioperative adrenomedullin levels among patients with congenital heart disease with and without pulmonary hypertension. Methods. Levels of plasma adrenomedullin, endothelin-1, and nitric oxide metabolites were measured in three groups: (1) low pulmonary flow (n = 11); (2) high flow/low pulmonary arterial pressure (less than 60% systemic pressure) (n = 9); and (3) high flow/high pressure (n = 10). Samples were obtained preoperatively, on and off pump, and 3, 6, and 12 hours after bypass. Results. Adrenomedullin levels were highest in the low pulmonary flow group (189.7 ± 15 pg/mL low flow versus 103.1 ± 9.5 pg/mL high flow/low pulmonary and 139 ± 17.5 pg/mL high flow/high pressure at 12 hours; p ≤ 0.05). The arterial pressure/systemic pressure remained significantly lower in the high flow/low pulmonary pressure compared with the high flow/high pressure group (0.37 ± 0.08 versus 0.62 ± 0.11; p < 0.005). Perioperative endothelin-1 and nitric oxide levels remained low in the low pulmonary flow group but increased progressively in both high flow groups. Conclusions. Circulating plasma adrenomedullin appears to affect baseline vascular tone in patients with intact endothelial function. It may interact with nitric oxide and endothelin-1 to help regulate blood pressure perioperatively in patients with congenital heart disease.

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