Abstract
Background
Angiopoietin-2 (Angpt2) mediates endothelial dysfunction (ED) following coronary artery bypass grafting (CABG). Its triggers are, however, poorly understood.
Methods
We examined the time course of ED beyond the early phase of postoperative recovery in 75 patients following CABG with a special focus on different cardiopulmonary bypass (CPB) modes as potential triggers of Angpt2 release.
Results
Nine patients (12.0%) underwent off-pump coronary artery bypass (OPCAB), 31 patients (41.3%) received minimized extracorporeal circulation (MECC), and 35 patients (46.6%) were operated on with (conventional) CPB. Angpt2 levels steadily increased across the observation period (1.7 [1.4–2.1] to 3.4 [2.5–6.1] ng/ml, p < 0.001). Angpt2 levels did not differ between the MECC and CPB groups (p = 0.564). There was no difference between MECC and CPB patients regarding net fluid balance (p = 0.821) and other surrogate markers of postoperative ED. The magnitude of Angpt-2 increase correlated more strongly with baseline C‑reactive protein (r = 0.459, p < 0.001) than with any other parameter. Hospital length of stay correlated more strongly with baseline Angpt2 levels (r = 0.512, p = 0.005) than with follow-up Angpt2 levels and appeared not to be influenced by CPB mode (p = 0.428).
Conclusion
CABG is associated with prolonged ED, which is determined by the patient’s preoperative inflammatory state rather than by CPB modifications.
Zusammenfassung
Hintergrund
Angiopoietin-2 (Angpt2) führt zur endothelialen Dysfunktion (ED) nach Koronararterien-Bypass-Operation (CABG). Über seine Trigger ist jedoch bislang nur wenig bekannt.
Methoden
Die Autoren untersuchten den Zeitverlauf der ED jenseits der Frühphase der postoperativen Genesung bei 75 Patienten nach CABG mit speziellem Fokus auf den verschiedenen Arten des kardiopulmonalen Bypass (CPB) als potenziellem Trigger der Angpt2-Freisetzung.
Ergebnisse
Bei 9 Patienten (12,0 %) erfolgte eine CABG ohne Herz-Lungen-Maschine („off-pump coronary artery bypass“, OPCAB), bei 31 Patienten (41,3 %) unter Einsatz der minimierten extrakorporalen Zirkulation („minimized extracorporeal circulation“, MECC) und bei 35 Patienten (46,6 %) mit (konventionellem) CPB. Die Angpt2-Werte stiegen während der Beobachtungsphase ständig an (von 1,7 [1,4–2,1] bis 3,4 [2,5–6,1] ng/ml, p < 0,001). Dabei unterschieden sich die Angpt2-Werte nicht zwischen der MECC- und der CPB-Gruppe (p = 0,564). Auch gab es keinen Unterschied zwischen den Patienten mit MECC und denen mit CPB hinsichtlich der Nettoflüssigkeitsbilanz (p = 0,821) und anderer Surrogatmarker der postoperativen ED. Die Größenordnung des Angpt-2-Anstiegs war stärker mit dem Ausgangswert für C‑reaktives Protein korreliert (r = 0,459; p < 0,001) als mit einem der anderen Parameter. Die Verweildauer im Krankenhaus war stärker mit dem Ausgangswert für Angpt2 korreliert (r = 0,512; p = 0,005) als mit den Folgewerten für Angpt2 und schien nicht durch die Art des CPB beeinflusst zu werden (p = 0,428).
Schlussfolgerung
Eine CABG ist mit prolongierter ED assoziiert, die eher durch den präoperativen Entzündungsstatus des Patienten bestimmt wird als durch Modifikationen des CPB.
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Abbreviations
- Angpt2:
-
angiopoietin-2
- BMI:
-
body mass index
- CABG:
-
coronary artery bypass grafting
- CPB:
-
cardiopulmonary bypass
- CRP:
-
C-reactive protein
- ICU:
-
intensive care unit
- LOS:
-
length of stay
- MECC:
-
minimized extracorporeal circulation
- OPCAB:
-
off-pump coronary artery bypass
- SOFA:
-
sequential organ failure assessment
- WBC:
-
white blood cell count
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Acknowledgements
We are grateful for the help of Jan Reck, Tom Kreft, and Christian Ulrich, who assisted in the acquisition of serum samples.
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J. Hadem, R. Rossnick, B. Hesse, M. Herr, M. Hansen, A. Bergmann, G. Kensah, C. Maess, H. Baraki, P. Kümpers, A. Lukasz, and I. Kutschka declare that they have no competing interests.
The study adhered to the ethical guidelines of the 1975 Declaration of Helsinki, was approved by the local ethics committee (approval number 51/15), and was registered at the German Clinical Trials Register (DRKS study number 00008855). All patients provided informed consent prior to study entry.
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Listing of significant correlations (Spearman) of Angiopoietin-2 and hospital length of stay with selected patient-inheritant, inflammatory and endothelial markers
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Hadem, J., Rossnick, R., Hesse, B. et al. Endothelial dysfunction following coronary artery bypass grafting. Herz 45, 86–94 (2020). https://doi.org/10.1007/s00059-018-4708-0
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DOI: https://doi.org/10.1007/s00059-018-4708-0