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A transthoracic Doppler echocardiography study of C-reactive protein and coronary microcirculation in children after open heart surgery

Published online by Cambridge University Press:  01 October 2007

Elhadi H. Aburawi ,
Petru Liuba ,
Ansgar Berg  and
Erkki Pesonen
Elhadi H. Aburawi*
Affiliation:
Department of Paediatrics, Division of Paediatric Cardiology, Lund University Hospital, Lund, Sweden
Petru Liuba
Affiliation:
Department of Paediatrics, Division of Paediatric Cardiology, Lund University Hospital, Lund, Sweden
Ansgar Berg
Affiliation:
Institute of Clinical Medicine, Section for Paediatrics, University of Bergen, Norway
Erkki Pesonen
Affiliation:
Department of Paediatrics, Division of Paediatric Cardiology, Lund University Hospital, Lund, Sweden
*
Correspondence to: Elhadi Hussein Aburawi MD, MSc, FRCPI, FRCPCH, Division of Pediatric Cardiology/Department of Pediatrics, Lund University Hospital, SE-221 85 Lund, Sweden. Tel: +46 46 17 82 61; Fax: +46 46 17 81 50; E-mail: [email protected]
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Abstract

Background

Systemic inflammation has been suggested to underlie in part the elevated risk of arrhythmias and myocardial dysfunction during the first weeks after cardiac surgery. Recent transthoracic Doppler studies from our centre indicated increased basal coronary arterial flow in children 5 days after cardiopulmonary bypass surgery. In these children, we investigated whether the inflammatory mediator, C-reactive protein, could influence this association.

Methods

The peak flow velocity, velocity time-integral in diastole and systole, and basal blood flow in the proximal part of the left anterior descending artery, were assessed by transthoracic Doppler echocardiography 1 day before, and 5 days after, cardiac surgery in 17 children with ventricular and atrioventricular septal defects whose mean age at surgery was 6 months. Levels of C-reactive protein in the plasma were measured at both time-points.

Results

Prior to surgery, all children had levels of C-reactive protein under the limit for detection, that is less than 0.8 milligrams per litre. The levels of the protein had increased significantly by the second day, when the median value was 25, and the range from 20 to 142 milligrams per litre. They remained elevated on the fifth day after surgery, when the median was 11, and the range from 3 to 20 milligrams per litre. On the fifth day, the percentage increase in velocity time integral corrected for left ventricular mass was significantly lower in those patients with C-reactive protein greater than or equal to 10 milligrams per litre than in the remaining patients. Also, both the velocity time integral and the velocity of diastolic peak flow correlated inversely with log C-reactive protein, r being equal to −0.54 and p less than 0.02 and r equal to −0.74 and p less than 0.01, respectively, particularly among those patients in whom clamping of the aorta lasted for more than 1 hour, r for this statistic being equal to −0.8.

Conclusion

The postsurgical increase in the velocity of coronary arterial flow in children is inversely associated with rising levels of C-reactive protein. The duration of the aortic cross-clamping during surgery strengthens the association between levels of C-reactive protein and the microcirculatory changes.

Keywords

Inflammationcoronary arteriespaediatric cardiologycongenital heart disease
Type
Original Article
Information
Cardiology in the Young , Volume 17 , Issue 5 , October 2007 , pp. 472 - 477
Copyright
Copyright © Cambridge University Press 2007

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References

1.Hassanabad, ZF, Furman, BL, Parratt, JR, Aughey, E. Coronary endothelial dysfunction increases the severity of ischaemia-induced ventricular arrhythmias in rat isolated perfused hearts. Basic Res Cardiol 1998; 93: 241–249.CrossRefGoogle ScholarPubMed
2.Verrier, ED, JrBoyle, EM. Endothelial cell injury in cardiovascular surgery. Ann Thorac Surg 1996; 62: 915–922.CrossRefGoogle ScholarPubMed
3.Franke, A, Lante, W, Fackeldey, V, et al. . Pro-inflammatory cytokines after different kinds of cardiothoracic surgical procedures: is what we see what we know? Eur J Cardiothorac Surg 2005; 28: 569–575.CrossRefGoogle ScholarPubMed
4.Bruins, P, te Velthuis, H, Yazdanbakhsh, AP, et al. . Activation of the complement system during and after cardiopulmonary bypass surgery: postsurgery activation involves C-reactive protein and is associated with postoperative arrhythmia. Circulation 1997; 96: 3542–3548.CrossRefGoogle ScholarPubMed
5.Wiklund, L, Ronquist, G, Roomans, GM, Rubertsson, S, Waldenstrom, A. Response of myocardial cellular energy metabolism to variation of buffer composition during open-chest experimental cardiopulmonary resuscitation in the pig. Eur J Clin Invest 1997; 27: 417–426.CrossRefGoogle ScholarPubMed
6.Paul, M. Ridker. C-reactive protein, inflammation, and cardiovascular disease clinical update. Tex Heart Inst J 2005; 32: 384–386.Google Scholar
7.Sternik, L, Samee, S, Schaff, HV, et al. . C-reactive protein relaxes human vessels in vitro Arterioscler. Thromb Vasc Biol 2002; 22: 1865–1868.CrossRefGoogle Scholar
8.Zhong, Y, Li, SH, Liu, SM, et al. . C-Reactive protein upregulates receptor for advanced glycation end products expression in human endothelial cells. Hypertension 2006; 48: 504–511.CrossRefGoogle ScholarPubMed
9. Aburawi EH, Berg A, Liuba P, Pesonen E. Effects of cardio-pulmonary bypass surgery on coronary flow in children assessed with transthoracic Doppler echocardiography. Am J Physiol Heart Circ Physiol. 2007 May 4; [Epub ahead of print].CrossRefGoogle Scholar
10.Hozumi, T, Yoshida, K, Ogata, Y, et al. . Noninvasive assessment of significant left anterior descending coronary artery stenosis by coronary flow velocity reserve with transthoracic color Doppler echocardiography. Circulation 1998; 97: 1557–1562.CrossRefGoogle ScholarPubMed
11.Saraste, M, Koskenvuo, J, Knuuti, J, et al. . Coronary flow reserve: measurement with transthoracic Doppler echocardiography is reproducible and comparable with positron emission tomography. Clin Physiol 2001; 21: 114–122.CrossRefGoogle ScholarPubMed
12.Devereux, RB, Alonso, DR, Lutas, EM, et al. . Echocardiographic assessment of left ventricular hypertrophy: comparison to necropsy findings. Am J Cardiol 1986; 57: 450–458.CrossRefGoogle ScholarPubMed
13.American Society of Echocardiography Committee. Recommendations for quantification of the left ventricle by two-dimensional echocardiography. J Am Soc Echocardiogr 1989; 2: 358–367.CrossRefGoogle Scholar
14.Hildick-Smith, DJ, Johnson, PJ, Wisbey, CR, Winter, EM, Shapiro, LM. Coronary flow reserve is supranormal in endurance athletes: an adenosine transthoracic echocardiography study. Heart 2000; 84: 383–389.CrossRefGoogle Scholar
15.Czernin, J, Muller, P, Chan, S, et al. . Influence of age and haemodynamics on myocardial blood flow and flow reserve. Circulation 1993; 88: 62–69.CrossRefGoogle ScholarPubMed
16.Baller, D, Bretschneider, HJ, Hellige, G. A critical look at currently used indirect indices of myocardial oxygen consumption. Basic Res Cardiol 1981; 76: 163–181.CrossRefGoogle Scholar
17.Paparella, D, Galeone, A, Venneri, MT, et al. . Blood damage related to cardiopulmonary bypass: in vivo and in vitro comparison of two different centrifugal pumps. ASAIO J 2004; 50: 473–478.CrossRefGoogle ScholarPubMed
18.Gaspardone, A, Versaci, F, Tomai, F, et al. . C-Reactive protein, clinical outcome, and restenosis rates after implantation of different drug-eluting stents. Am J Cardiol 2006; 97: 1311–1316.CrossRefGoogle ScholarPubMed
19.Wang, SY, Friedman, M, Franklin, A, Sellke, FW. Myogenic reactivity of coronary resistance arteries after cardiopulmonary bypass and hyperkalemic cardioplegia. Circulation 1995; 92: 1590–1596.CrossRefGoogle ScholarPubMed
20.Hiratzka, LF, Eastham, CL, Carter, JG, et al. . The effects of cardiopulmonary bypass and cold cardioplegia on coronary flow velocity and the reactive hyperemic response in patients and dogs. Ann Thorac Surg 1988; 45: 474–481.CrossRefGoogle ScholarPubMed
21.Verma, S, Li, SH, Badiwala, MV, et al. . Endothelin antagonism and interleukin-6 inhibition attenuate the proatherogenic effects of C-reactive protein. Circulation 2002; 105: 1890–1896.CrossRefGoogle ScholarPubMed
22.Pernow, J, Wang, QD. Endothelin in myocardial ischaemia and reperfusion. Cardiovasc Res 1997; 33: 518–526.CrossRefGoogle ScholarPubMed
23.Lafuente, N, Azcutia, V, Matesanz, N, et al. . Evidence for sodium azide as an artefact mediating the modulation of inducible nitric oxide synthase by C-reactive protein. J Cardiovasc Pharmacol 2005; 45: 193–196.CrossRefGoogle ScholarPubMed
24.Heltne, JK, Koller, ME, Lund, T, et al. . Dynamic evaluation of fluid shifts during normothermic and hypothermic cardiopulmonary bypass in piglets. Acta Anaesthesiol Scand 2000; 44: 1220–1225.CrossRefGoogle ScholarPubMed