Key result
Internal biliary drainage reduces elevated natriuretic peptides and improves LV systolic work within 4 days.
Why the study?
Patients with biliary obstruction have increased plasma levels of atrial natriuretic peptide, prompting investigation into myocardial function before and after internal biliary drainage.
Does internal biliary drainage improve myocardial hemodynamic function and reduce plasma natriuretic peptide levels in patients with newly diagnosed obstructive jaundice?
Cohort (n=13)
Does internal biliary drainage improve myocardial hemodynamic function and reduce plasma natriuretic peptide levels in patients with newly diagnosed obstructive jaundice?
Obstructive jaundice is associated with subclinical myocardial dysfunction and twofold to fourfold elevations in ANP and BNP that measurably improve 4 days after internal biliary drainage.
Internal biliary drainage was associated with improved hemodynamics in obstructive jaundice; leaves open whether this alters clinical outcomes or warrants routine use.
OBJECTIVE: To investigate myocardial function in patients with obstructive jaundice before and after internal biliary drainage. SUMMARY BACKGROUND DATA: Increased plasma levels of atrial natriuretic peptide (ANP) have been found in patients with biliary obstruction. METHODS: Thirteen patients with newly diagnosed obstructive jaundice and no previous heart, lung, or renal disease were studied using a Swan-Ganz catheter. Hemodynamic measurements were taken before and 4 days after internal biliary drainage. Levels of ANP and brain natriuretic peptide (BNP) were obtained and liver function tests were also determined. RESULTS: Plasma levels of ANP and BNP were increased twofold to fourfold in the basal state and declined after biliary drainage. Independent variables predicting left ventricular systolic work were total bilirubin concentrations, duration of jaundice, and BNP. In addition, bilirubin concentrations correlated with pulmonary vascular resistance, mean arterial pulmonary pressure, and right ventricular systolic work. Internal biliary drainage resulted in an improvement in left ventricular systolic work. A correlation was found between decreasing ANP concentrations and increasing cardiac output. CONCLUSIONS: Increased plasma levels of natriuretic peptides in patients with obstructive jaundice may reflect a subclinical myocardial dysfunction correlating with the degree of jaundice. After internal biliary drainage, there is a measurable improvement of cardiac function.
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Ruiz et al. (2001) conducted a cohort in Newly diagnosed obstructive jaundice (n=13). Internal biliary drainage vs. Basal pre-drainage state was evaluated on Myocardial hemodynamic function (left ventricular systolic work, cardiac output) and plasma levels of ANP and BNP. Internal biliary drainage reduced elevated basal ANP and BNP levels (initially increased 2- to 4-fold) and improved left ventricular systolic work at 4 days.
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