Evaluation of Pericardial Fluid C-Type Natriuretic Peptide Levels in Patients Undergoing Coronary Bypass Surgery
06 September 2015
21 January 2016
10 March 2016 (online)
Background Neurohumoral and hemodynamic mechanisms have an effect on cardiac activity. C-type natriuretic peptide (CNP) is accessible in the cardiovascular system. The aim of this study was to determine whether CNP concentrations in pericardial fluid and blood are related to cardiac dysfunction in patients undergoing coronary artery bypass graft surgery.
Materials and Methods In this study, 40 patients undergoing coronary artery bypass grafting were enrolled. The patients were separated into two groups according to left ventricular (LV) ejection fraction (EF): group 1 contained 28 patients with normal LV systolic function (LVEF ≥ 50%) and group 2 contained 12 patients with impaired LV systolic function (LVEF < 45%). Plasma and pericardial fluid samples were acquired during surgery to measure CNP levels.
Results In group 1, CNP levels were detected to be 0.46 ± 0.10 ng/mL in plasma and 0.66 ± 0.8 ng/mL in pericardial liquid. In group 2, these levels were 0.51 ± 0.09 and 0.79 ± 0.12 ng/mL, respectively. CNP levels were determined to be significantly higher in patients with low EF compared with those with normal EF in pericardial fluid concentrations (p = 0.013).
Conclusions CNP level in pericardial fluid is a more sensitive and proper marker of LV dysfunction than CNP levels in plasma. To the best of our knowledge, this study is the first to examine pericardial fluid CNP levels in patients undergoing coronary artery bypass surgery. It may have a valuable role in organizing cardiac remodeling and hypertrophy.
- 1 Ben-Horin S, Shinfeld A, Kachel E, Chetrit A, Livneh A. The composition of normal pericardial fluid and its implications for diagnosing pericardial effusions. Am J Med 2005; 118 (6) 636-640
- 2 Ege T, Us MH, Cikirikcioglu M, Arar C, Duran E. Analysis of C-reactive protein and biochemical parameters in pericardial fluid. Yonsei Med J 2006; 47 (3) 372-376
- 3 Klemola R, Tikkanen I, Vuolteenaho O, Toivonen L, Laine M. Plasma and pericardial fluid natriuretic peptide levels in postinfarction ventricular dysfunction. Eur J Heart Fail 2001; 3 (1) 21-26
- 4 Inoue K, Naruse K, Yamagami S, Mitani H, Suzuki N, Takei Y. Four functionally distinct C-type natriuretic peptides found in fish reveal evolutionary history of the natriuretic peptide system. Proc Natl Acad Sci U S A 2003; 100 (17) 10079-10084
- 5 Turkdogan KA, Zorlu A, Engin A , et al. C-type natriuretic peptide is associated with the severity of Crimean-Congo hemorrhagic fever. Int J Infect Dis 2012; 16 (8) e616-e620
- 6 Chauhan SD, Nilsson H, Ahluwalia A, Hobbs AJ. Release of C-type natriuretic peptide accounts for the biological activity of endothelium-derived hyperpolarizing factor. Proc Natl Acad Sci U S A 2003; 100 (3) 1426-1431
- 7 Kühnl A, Pelisek J, Tian W , et al. C-type natriuretic peptide inhibits constrictive remodeling without compromising re-endothelialization in balloon-dilated renal arteries. J Endovasc Ther 2005; 12 (2) 171-182
- 8 Kuehnl A, Pelisek J, Pongratz J, Eckstein HH. C-type natriuretic peptide and its receptors in atherosclerotic plaques of the carotid artery of clinically asymptomatic patients. Eur J Vasc Endovasc Surg 2012; 43 (6) 649-654
- 9 Omland T. B-type natriuretic peptides: prognostic markers in stable coronary artery disease. Expert Rev Mol Diagn 2008; 8 (2) 217-225
- 10 Tokudome T, Horio T, Soeki T , et al. Inhibitory effect of C-type natriuretic peptide (CNP) on cultured cardiac myocyte hypertrophy: interference between CNP and endothelin-1 signaling pathways. Endocrinology 2004; 145 (5) 2131-2140
- 11 Totsune K, Takahashi K, Murakami O, Satoh F, Sone M, Mouri T. Elevated plasma C-type natriuretic peptide concentrations in patients with chronic renal failure. Clin Sci (Lond) 1994; 87 (3) 319-322
- 12 Hobbs A, Foster P, Prescott C, Scotland R, Ahluwalia A. Natriuretic peptide receptor-C regulates coronary blood flow and prevents myocardial ischemia/reperfusion injury: novel cardioprotective role for endothelium-derived C-type natriuretic peptide. Circulation 2004; 110 (10) 1231-1235
- 13 Wang Y, de Waard MC, Sterner-Kock A , et al. Cardiomyocyte-restricted over-expression of C-type natriuretic peptide prevents cardiac hypertrophy induced by myocardial infarction in mice. Eur J Heart Fail 2007; 9 (6–7): 548-557
- 14 Soeki T, Kishimoto I, Okumura H , et al. C-type natriuretic peptide, a novel antifibrotic and antihypertrophic agent, prevents cardiac remodeling after myocardial infarction. J Am Coll Cardiol 2005; 45 (4) 608-616
- 15 Hama N, Itoh H, Shirakami G , et al. Detection of C-type natriuretic peptide in human circulation and marked increase of plasma CNP level in septic shock patients. Biochem Biophys Res Commun 1994; 198 (3) 1177-1182
- 16 Ohno N, Itoh H, Ikeda T , et al. Accelerated reendothelialization with suppressed thrombogenic property and neointimal hyperplasia of rabbit jugular vein grafts by adenovirus-mediated gene transfer of C-type natriuretic peptide. Circulation 2002; 105 (14) 1623-1626
- 17 Kiemer AK, Lehner MD, Hartung T, Vollmar AM. Inhibition of cyclooxygenase-2 by natriuretic peptides. Endocrinology 2002; 143 (3) 846-852
- 18 Casco VH, Veinot JP, Kuroski de Bold ML, Masters RG, Stevenson MM, de Bold AJ. Natriuretic peptide system gene expression in human coronary arteries. J Histochem Cytochem 2002; 50 (6) 799-809