Effects Of ACE Inhibitors And β-receptor Blockers On Neuroendocrine Hormones And Cardiac Structure And Function In Patients After Valve Replacement

Objective:By comparing neuroendocrine hormone levels between different drug treatment group and the dynamic changes after operation, to understand the effects of ACEI andβ-blockers on the neuroendocrine hormone after valve replacement, to guide the drug treatment and drug compatibility, to further improve cardiac function after surgery, and to understand the effects on cardiac structure and cardic function in which received medication-assisted therapy after the operation.Patients and Methods:From 2009.04 to 2009.10,60 patients underwent mechanical heart valve replacement operation without complications at the Department of cardiothoracic surgery in our hospital were enrolled into our study. They were randomly divided into A,B,C groups and given adjuvant treatment of different drugs. After operation, A group to be routine cardiocinetic,diuretic therapy, B group to be routine cardiocinetic,diuretic and ACEI therapy, C group to be routine cardiocinetic,diuretic,ACEI andβ-blocker therapy. We taken blood samples in the preoperative and postoperative 1 week,2weeks,4weeks,8weeks and 16weeks,to determination plasma level of AngiotensinⅡ,aldosterone and atrial natriuretic peptide; Have a echocardiography respectively in the preoperative and postoperative 2weeks,8weeks and 16weeks to measurement of left atrial end-diastolic diameter(LAD),left,right ular end-diastolic diameter(LVDD, RVDD) and left ventricular fractional shortening(LVFS) and left ventricular ejection fraction(LVEF). To understanding the dynamic changes of neuroendocrine hormone levels and the relationship between this change and cardiac structure and function's change after valve replacement.Results:1. Neuroendocrine hormone levelsAfter valve replacement surgery, plasma AngⅡ, ANP, ALD concentrations at all time measured compared with the preoperative levels were no significant differences (P> 0.05) in A group. But in B group and C group, compared with the preoperative and postoperative 1 week the plasma ANP concentrations have no significantly change (P> 0.05), plasma ANP concentrations measured in postoperative 2 weeks started to decline (P< 0.05), to 4 weeks after operation those concentrations decreased significantly (P <0.01), at 8 weeks and 16 weeks after the operation the concentrations present progressively decreased (P <0.01); compared with the preoperative, plasma ALD concentrations start to decline until 4 weeks after operation(P <0.01), and then present progressively decreased(P <0.01); until postoperative 16 weeks the plasma AngⅡconcentrations in B group have a significantly decrease (P< 0.05); and in C group the plasma AngⅡconcentrations have significantly decrease in 8 weeks after operation(P <0.05). Compared with B group and C group, plasma AngⅡ, ALD concentrations decreased level after operation have no significant difference(P> 0.05) ,but the plasma ANP concentrations decreased level in C group are better than B group(P< 0.05).2. Cardiac structure and functionAll patients in 2 weeks,8 weeks and 16 weeks after the operation have color Doppler ultrasound examination detected cardiac left ventricular end-diastolic diameter (LVDD) and left ventricular ejection fraction (LVEF ), compared with preoperative have no significant difference(P> 0,05). Postoperative 2 weeks all patients have the color Doppler examination measured left atrial end-diastolic diameter (LAD), right ventricular end-diastolic diameter (RVDD) and left ventricular fractional shortening (LVFS) ,compared with the preoperative,all of the values decreased (P <0.05). Postoperative 8 weeks and 16 weeks the LAD, RVDD have no significant changes compared with Postoperative 2 weeks in A group, while LVFS improvement (P <0.05),but have no significant changes compared with preoperative (P >0.05). Postoperative 8 weeks and 16 weeks the LAD, RVDD present progressively decreased (P <0.05) and LVFS present progressively increased (P <0.05) in B group and C group, compared with the preoperative were significantly difference (P <0.01), the degree of improvement of LVFS in C group better than B group (P <0.05).Conclusions:Patients after mechanical heart valve replacement surgery to be routine cardiocinetic,diuretic therapy,and in addition supplemented ACEI and / orβ-blocker treatment can effectively reduce the neuroendocrine hormone levels in patients and help to improve cardiac function and structure. ACEI combinedβ-blocker use compared with ACEI alone in patients with mechanical heart valve replacement after the functional recovery of more helpful. Medication-assisted therapy to 2 weeks after surgery, neuro-endocrine hormone levels, heart structure and function gradually improved.