Natriuretic Peptide System Gene Variants Are Associated with Ventricular Dysfunction After Coronary Artery Bypass Grafting Amanda A
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Ⅵ 2008 BEST ABSTRACTS OF THE MEETING: ANESTHESIOLOGY EDITORS’ PICKS Anesthesiology 2009; 110:738–47 Copyright © 2009, the American Society of Anesthesiologists, Inc. Lippincott Williams & Wilkins, Inc. Natriuretic Peptide System Gene Variants Are Associated with Ventricular Dysfunction after Coronary Artery Bypass Grafting Amanda A. Fox, M.D.,* Charles D. Collard, M.D.,† Stanton K. Shernan, M.D.,‡ Christine E. Seidman, M.D.,§ Jonathan G. Seidman, Ph.D.,͉͉ Kuang-Yu Liu, Ph.D.,* Jochen D. Muehlschlegel, M.D.,* Tjorvi E. Perry, M.D.,* Sary F. Aranki, M.D.,# Christoph Lange, Ph.D.,** Daniel S. Herman,†† Thomas Meitinger, M.D.,‡‡ Peter Lichtner, Ph.D,§§ Simon C. Body, M.B.Ch.B., M.P.H.͉͉͉͉ Downloaded from http://pubs.asahq.org/anesthesiology/article-pdf/110/4/738/368353/0000542-200904000-00013.pdf by guest on 25 September 2021 Background: Ventricular dysfunction (VnD) after primary myocardial failure and ischemia. The authors hypothesized that coronary artery bypass grafting is associated with increased natriuretic peptide system gene variants independently predict hospital stay and mortality. Natriuretic peptides have compen- risk of VnD after primary coronary artery bypass grafting. satory vasodilatory, natriuretic, and paracrine influences on Methods: A total of 1,164 patients undergoing primary coro- nary artery bypass grafting with cardiopulmonary bypass at two institutions were prospectively enrolled. After prospec- This article is featured in “This Month in Anesthesiology.” tively defined exclusions, 697 patients of European descent (76 ᭛ Please see this issue of ANESTHESIOLOGY, page 9A. with VnD) were analyzed. VnD was defined as need for at least 2 new inotropes and/or new mechanical ventricular support This article is accompanied by an Editorial View. Please see: after coronary artery bypass grafting. A total of 139 haplotype- ᭜ Eisenach JH, Schroeder DR: Genomic discoveries in perioper- tagging single nucleotide polymorphisms (SNPs) within 7 genes ative medicine: Educating the audience. ANESTHESIOLOGY 2009; (NPPA, NPPB, NPPC, NPR1, NPR2, NPR3, CORIN) were geno- 110:693–5. typed. SNPs univariately associated with VnD were entered into logistic regression models adjusting for clinical covariates pre- Supplemental digital content is available for this article. Direct dictive of VnD. To control for multiple comparisons, permuta- URL citations appear in the printed text and are available in tion analyses were conducted for all SNP associations. both the HTML and PDF versions of this article. Links to the Results: After adjusting for clinical covariates and multiple digital files are provided in the HTML text of this article on the comparisons within each gene, seven NPPA/NPPB SNPs Journal’s Web site (www.anesthesiology.org). (rs632793, rs6668352, rs549596, rs198388, rs198389, rs6676300, rs1009592) were associated with decreased risk of postopera- –0.010 ؍ tive VnD (additive model; odds ratios 0.44–0.55; P * Instructor, ‡ Associate Professor, ͉͉͉͉ Assistant Professor, Department of 0.036) and four NPR3 SNPs (rs700923, rs16890196, rs765199, Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s rs700926) were associated with increased risk of postoperative .(0.034–0.007 ؍ Hospital, Harvard Medical School, Boston, Massachusetts; † Professor, Baylor VnD (recessive model; odds ratios 3.89–4.28; P College of Medicine Division of Cardiovascular Anesthesia at the Texas Heart Conclusions: Genetic variation within the NPPA/NPPB and Institute, Saint Luke’s Episcopal Hospital, Houston, Texas; § Professor, De- partment of Genetics, Harvard Medical School, Boston, Massachusetts, and NPR3 genes is associated with risk of VnD after primary coro- Division of Cardiology, Brigham and Women’s Hospital, Harvard Medical nary artery bypass grafting. Knowledge of such genotypic pre- School, Boston, Massachusetts; ͉͉ Professor, Department of Genetics, Harvard dictors may result in better understanding of the molecular Medical School, Boston, Massachusetts; # Associate Professor, Division of Cardiac Surgery, Brigham and Women’s Hospital, Harvard Medical School, mechanisms underlying postoperative VnD. Boston, Massachusetts; ** Associate Professor, Harvard School of Public Health, Boston, Massachusetts; †† M.D., Ph.D., degree candidate, Department of Genetics, Harvard Medical School, Boston, Massachusetts; ‡‡ Professor, VENTRICULAR dysfunction (VnD) has been reported Institute of Human Genetics, Helmholtz Zentrum Mu¨nchen German Research 1–3 Center for Environmental Health (GmbH), Neuherberg, Germany; §§ Institute after cardiac surgery in 10–20% of patients and has of Human Genetics, Helmholtz Zentrum Mu¨nchen German Research Center been associated with increased hospital stay and long- for Environmental Health (GmbH), Neuherberg, Germany. term mortality after primary coronary artery bypass graft Received from the Department of Anesthesiology, Perioperative and Pain 2 Medicine, Brigham and Women’s Hospital, Boston, Massachusetts. Submitted (CABG) surgery with cardiopulmonary bypass (CPB). for publication September 12, 2008. Accepted for publication December 30, B-type natriuretic peptide (BNP) is a member of the 2008. Supported by Biosite Incorporated, San Diego, California; a Research Starter Grant from the Society of Cardiovascular Anesthesiologists, Richmond, natriuretic peptide family, which includes three structur- Virginia (to Dr. Fox); a Research Starter Grant from the Foundation for ally homologous peptides: A-type (ANP), BNP, and C- Anesthesia Education and Research, Rochester, Minnesota (to Dr. Fox); 4 Eleanor and Miles Shore Fellowship from Harvard Medical School via the type natriuretic peptides. ANP and BNP are primarily Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and released from atrial and ventricular myocytes in re- Women’s Hospital, Boston, Massachusetts (to Dr. Fox); grant no. K23- HL068774 National Institute of Health, Bethesda, Maryland (to Dr. Body); the sponse to increased cardiac atrial and ventricular wall Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and 4 Women’s Hospital, Boston, Massachusetts; and the Baylor College of Medicine stress. C-type natriuretic peptide is released from vas- 4 Division of Cardiovascular Anesthesia at the Texas Heart Institute, Saint Luke’s cular endothelial cells and other tissues. Natriuretic Episcopal Hospital, Houston, Texas. Presented at the Annual Meeting of the Amer- ican Society of Anesthesiologists, Orlando, Florida, October 20, 2008. peptides bind to two guanylyl cyclase-coupled effector Address correspondence to Dr. Fox: Department of Anesthesiology, Peri- receptors (natriuretic peptide receptors A and B) and a operative and Pain Medicine, Brigham and Women’s Hospital, 75 Francis clearance receptor (natriuretic peptide receptor C). In Street, Boston, Massachusetts 02115. [email protected]. This article may be accessed for personal use at no charge through the Journal Web site, addition to compensatory natriuretic, diuretic, and va- www.anesthesiology.org. sorelaxant properties, natriuretic peptides also have mit- Anesthesiology, V 110, No 4, Apr 2009 738 NATRIURETIC PEPTIDE GENES AND VENTRICULAR DYSFUNCTION 739 igating paracrine influences on myocardial ischemia– genomic control single nucleotide polymorphisms reperfusion injury and cardiovascular remodeling.4–14 (SNPs) indicated non-European ethnicity.25 Circulating plasma BNP levels are used to assess the severity of heart failure and myocardial ischemia and to Data and Blood Collection predict adverse outcomes in patients with acute coronary Data were collected for each enrolled subject during syndromes or undergoing cardiovascular surgery.1,2,15–18 primary hospitalization using a detailed prospectively Natriuretic peptide system gene variants have been as- designed study case report form that includes: (1) pre- sociated with cardiovascular disease states such as hy- operative demographic characteristics, comorbidities, pertension,19–21 stroke,22,23 and myocardial infarction.24 and medications; (2) surgical characteristics; and (3) However, to date, the association between natriuretic postoperative in-hospital events. Data were subject to peptide system gene variants and development of VnD automated range and logic checking as well as additional Downloaded from http://pubs.asahq.org/anesthesiology/article-pdf/110/4/738/368353/0000542-200904000-00013.pdf by guest on 25 September 2021 after cardiac surgery with CPB has not been examined. manual audit of a proportion of records. Knowledge of such genotypic predictors may enhance Plasma samples obtained preoperatively and on post- our understanding of the molecular mechanisms under- operative days 1–5 were stored in vapor-phase liquid lying postoperative VnD. We thus hypothesized that nitrogen until analysis. Plasma BNP and cTnI were mea- variants within the natriuretic peptide precursor protein sured at all time points using immunoassays conducted (NPPA, NPPB, NPPC), receptor (NPR1, NPR2, NPR3), at a single reference laboratory (Biosite, San Diego, CA). and precursor converting enzyme (CORIN) genes are DNA was extracted from white blood cells using stan- independently associated with the risk of postoperative dard procedures. Genotyping was performed using Se- VnD in patients of European descent undergoing pri- quenom MassARRAY® iPLEX (Sequenom, San Diego, mary CABG surgery with CPB. CA) at Helmholtz Zentrum Mu¨nchen (Neuherberg, Ger- many). Raw genotyping signals were analyzed with Spec- troTyper 3.4 software (Sequenom)