Koroner baypas ameliyatı geçiren iskemik kardiyomyopatili hastalarda Growth hormon infüzyonunun akut hemodinamik etkileri

Amaç: İskemik kardiyomyopatinin cerrahi tedavisi ciddi riskler taşımaktadır. Çalışmada, deprese ventriküllü hastalarda koroner arter bypass cerrahisi sonrası, growth hormon kullanımının kardiyak performansa etkisinin incelenmesini amaçladık. Materyal-metod: Kliniğimizde Haziran 1999 - Şubat 2001 tarihleri arasında elektif şartlarda koroner arter bypass cerrahisi uygulanan, deprese ventriküllü 80 hasta (ortalama EF:22%±5 ) çalışma kapsamına alınmıştır. Hastalar prospektif, randomize olarak iki gruba ayrılmış olup Grup I (38 hasta) konvansiyonel yöntemlere ek olarak kardiyopulmoner bypass'tan çıkmadan hemen önce Growth hormon infüzyonu alırken, Grup II (42 hasta) kontrol grubunu oluşturmuştur. Preoperatif dönemde profilaktik olarak grup 1'de 10 hastada ( %26.3) ve grup 2'de 11 hastada ( % 26.2) intraaortik balon pompası (IABP) yerleştirdik. Growth hormon ve kontrol grupları arasında preoperatif demografik ve hemodinamik parametreler ile operatif bulgular açısından bir farklılık yoktu. Sonuç: Toplam mortalite %3.8 idi (Grup I: 1 hasta, % 2.6, Grup II: 2 hasta, %4.7, p=0.56). Postoperatif komplikasyonlar (aritmi, stroke, renal veya solunum yetmezliği, sternal enfeksiyon, uzamış solunum desteği) açısından her iki grup arasında anlamlı bir farklılık saptanmadı. Ancak, postoperatif ortalama dobutamin dozu (5±1.2µgr/kg/saat'e karşı 8±1.1µgr/kg/saat, p=0.01) ve IABP destek gereksinimi (18 e karşı 28, p=0.04) GH grubu hastalarında kontrol grubuna göre anlamlı olarak az bulunmuştur. Tartışma: Koroner baypas operayonuna alınan depresif ventriküllü hastalarda proflaktik olarak uygulanan GH infüzyonu, olumsuz yan etki göstermeksizin postoperatif inotropik ilaç ve İABP gereksinimini azaltmaktadır.

Hemodynamic effects of Growth hormone infusion in patient with ischemic cardiomyopathy undergone coronary artery bypass surgey

Background: Ischemic cardiomyopathy serious risk for surgical treatment in this study, we aimed to view the effect of growth hormone on cardiac performance in the patient with depressed ventricle after coronary surgery. Material and Method: In Ankara University Faculty of Medicine, Cardiovascular Surgery Department, between June 1999-February 2001, we study the 80 patients with depressed ventricle (ejection fraction 22±5%) undergone coronary artery bypass surgery in elective conditions. Patients are separated in 2 prospective randomised groups; GroupI (38 patients), beyond the convensional techniques, they had been given GH infusion right before terminating cardiopulmonary bypass, GroupII (42 patients) in accepted as control group. As a prophylaxis 10 patients in groupI (26.3%) are inserted IABP in preoperative period. Between 2 groups there were no significant difference concerning demographic and hemodynamic parameters. Result: Total mortality was 3.8% (1 exitus in groupI 2.6%, 2 patients in groupII 4.7%, p=0.56). There were no difference concerning postoperative complications (arrythmia, stroke, renal and respiratory insufficiency, sternal infection, prolonged respiratory support). However, there were significant decrease in control group according to test group concerning mean dobutamin dose (5±1.2 µg/kg/hr. verses 8±1.1 µg/kg/hr, p=0.01) and need for IABP support (18 versus 28, p=0.04). Conclusion: In patients with depressed ventricle after coronary surgery prophylactic growth hormone infusion, decreases the need for the IABP and postoperative inotropics drugs without any side effect.

PDF

___

1. Rudman D, Feller AG, Nagraj HS, et al. Effects of human growth hormon in men over over 60 years old. NEnglJMed. 1990;323:1-6.
2. Giustina A, Wehrenberg WB. Growth hormone ne- uroregulation in diabetes mellitus. Trends Endpcri- nol Metab ~ 994;5:73-78.
3. Yang R, Bunting S, Gillett N, et al . growth hormone improves cardiac performance in experimental he¬ art failure. Circulation. 1995;92:262-267.
4. Stromer H, Cittadini A, Douglas PS, Morgan JP. Exo- genously administired growth hormon and insulin like growth factorr1 alter intracellular Ca^+ hand¬ ling and enhance cardiac performance. Ore ResA996;79-.227-236.
5. Mayoux E, Ventura-Clapier R, Timsit J, et al. Mecha¬ nical properties of rat cardiac skinned fibers are al¬ tered by choronic growth hormon hypersecretion. Ore Res. 1993;72:57-64.
6. Sacca L, Cittadini A, Fazio S. Growth hormon and the heart. Endocr Rev. 1994;15:555-573.
7. Fazio S, Sabitini D, Capaldo B, et al. A preliminary study of growth hormone in the treatment of dilated cardiomyopathy. N Engl J Med. 1996;334:8O9-814.
8. Sacca L, Fazio S. Cardiac performance: growth hor¬ mon enters the race. Nat Med. 1996;2:29-31.
9. Thuesen L, Chistiansen JS, Sorensen KE, et al. Incre¬ ased myocardial contrctility following growth hor¬ mone administration in normal man. Dan Med Bull. 1988;35:193-6.
10. Volterrani M, Desanzani P, Lorusso R, et al. He- modynamic effects of intavenous growth hormone in congestive heart failure. Lancet 1997;349:1067- 68.
11. Marc Y. Donath, Gabor Sütsch, Xia-Wei Yan, et al. Acute cardiovascular effects of insulin-like growth factor-i in patients with choronic heart failure. J Clin Endocrinol Metab 1998 83;9:3177-3183.
12. Giustina A, Girelli A, Alberti D, et al. Effects of pri- dostigmine on spontenous and growth hormone- releasing hormone stimulated growth hormone sec¬retion in childeren on daily glucocorticoid treatment after liver transplantation. Clin Endocrinol (Oxf) 1991;35:49l-8.
13.Jorgensen JOL, Moller N, Lauritzen T, et al. Pulsati¬le versus continous intravenous administration of growth hormone (GH) in GH-deficiency patienta: effects on circulating insulin-like growth factor-1 and metabolic indices. / Clin Endocrinol Metab 1990;70:1616-23.
14. Osterziel KJ, Strohm O, Schuler J, et al. Randomi¬ sed, double lind, placebo-controlled trial of human recombinant growth hormone in patients with cho¬ ronic heart failure due to dilated cardiomyopathy. Lancet 1998 Apr 25;351 (9111 ):1233-7.
15. Wetter U, Kupferschmid C, Lang D, et al. Insulin-li¬ ke growth factors and insulin increase the contracti¬ lity of neonatal rat cardiocytes in vitro. Basic Res Cardiol 1988;83:647-54.
16. Ambler GR, Johnston BM, Mxwell L, et al. Improve¬ ment of doxorubicin induced cardiomyopathy in rats treated with insulin-like growth factor 1. Cardi- ovasc Res-[ 993;27-A 368-73.
17. Biddle TL, Benotti JR, Creager MA, et al. Compara- sion of intravenous milrinone and dobutamine for congestive heart failure secondary to either ische- mic or dilated cardiomyopathy. Am J Cardiol. 1987;59:1345-50.
18. Eichhom EJ, Konstam MA, Weiland DS, et al. Differ- nial effects of milrinone and dobutamine on right ventricular preload, afterload and systolic perfor¬ mance in congestive heart failure secondary to isc- hemic or idiopatic dilated cardiomyopathy. Am J Carc//o/1987;60:1329-33.
19. Grose R, Strain J, Greenberg M, et al. Systemic and coranary effects of intravenous milrinone and dobu¬ tamine in congestive heart failure. Am J Cardiol 1986;7:1107-13.