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  • Title: Changes of plasma beta-endorphin levels before and after percutaneous transvenous mitral commissurotomy in patients with mitral stenosis.
    Author: Yin R, Zhu S, Zhao D, Toa X, Zeng Z, Xia S.
    Journal: Chin Med J (Engl); 1995 Nov; 108(11):812-9. PubMed ID: 8585972.
    Abstract:
    To clarify the contribution of left atrial pressure to the secretion of beta-endorphin, we have investigated the relation between plasma beta-endorphin levels and hemodynamic changes in 35 patients with mitral stenosis undergoing percutaneous transvenous mitral commissurotomy (PTMC). Before PTMC, plasma beta-endorphin levels obtained from the antecubital vein (28.91 +/- 5.59 pg/ml) and from the femoral vein (28.20 +/- 5.44 pg/ml) in the patients with mitral stenosis were significantly higher than those obtained from the antecubital vein in the healthy volunteers (22.59 +/- 3.86 pg/ml, n = 34, P < 0.001 for each). The levels of beta-endorphin in the femoral vein correlated well with the mean left atrial pressure (r = 0.777, P < 0.001) and the mean right atrial pressure (r = 0.450, P < 0.01) before the procedure. The antecubital venous levels of beta-endorphin in patients in New York Heart Association functional Classes II (26.45 +/- 5.39 pg/ml, n = 20) and III (32.20 +/- 4.02 pg/ml, n = 15) were significantly higher than those in control subjects (P < 0.005 and P < 0.001, respectively). The differences between Classes II and III were significant (P < 0.001). The plasma levels of beta-endorphin in the patients complicated with atrial fibrillation were also significantly higher than those in patients with normal sinus rhythm (33.31 +/- 3.22 pg/ml, n = 13 vs 26.32 +/- 5.07 pg/ml, n = 22, P < 0.001). In ten to fifteen minutes after commissurotomy, plasma levels of beta-endorphin in the femoral vein significantly increased from 28.20 +/- 5.44 to 33.14 +/- 5.72 pg/ml (P < 0.001). In seventy-two hours after the procedure, plasma beta-endorphin levels in the antecubital vein fell to 24.37 +/- 2.59 pg/ml (P < 0.001 vs before PTMC and P < 0.05 vs control subjects). Plasma beta-endorphin levels in the patients with atrial fibrillation (26.62 +/- 2.36 pg/ml, P < 0.001 vs before PTMC and P < 0.002 vs control subjects) were still higher (P < 0.001) than those in patients with normal sinus rhythm (23.05 +/- 1.65 pg/ml, P < 0.001 vs before PTMC and P > 0.50 vs control subjects. There was a significant correlation between the levels of beta-endorphin in the antecubital vein and heart rate (r = 0.502, P < 0.001), mean transmitral pressure gradient (r = 0.543, P < 0.001) or mitral valve area (r = -0.710, P < 0.001) before and 72 hours after the procedure.
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