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Transcardiac serotonin concentration is increased in selected patients with limiting angina and complex coronary
E K van den Berg1, J M Schmitz, C R Benedict
1Cardiac Catheterization Laboratory, Dallas VA Medical Center, TX 75216.
Insights
Serotonin is released in the coronary circulation of some patients with coronary artery disease, particularly those with complex lesions. Its exact role in unstable ischemic heart disease requires further investigation.
Area of Science:
- Cardiology
- Vascular Biology
- Biochemistry
Background:
- Platelet-released serotonin may contribute to unstable ischemic heart disease.
- Understanding serotonin's role in coronary syndromes is crucial.
Purpose of the Study:
- To investigate if serotonin concentration increases in the coronary bed of patients with severe angina.
- To explore the relationship between serotonin levels and coronary artery disease characteristics.
Main Methods:
- Measured central aortic and coronary sinus serotonin concentrations using radioenzymatic assay.
- Compared serotonin levels in patients with coronary artery disease (CAD) versus controls.
- Analyzed serotonin differences based on lesion complexity and patient symptoms.
Main Results:
- No overall difference in mean aortic or coronary sinus serotonin between groups.
- Elevated coronary sinus serotonin detected in 23% of CAD patients.
- Significant increase in coronary sinus-aortic serotonin difference in CAD patients, especially with irregular lesions.
Conclusions:
- Serotonin is released into the coronary circulation in some patients with coronary artery disease.
- Release is more pronounced in patients with frequent angina and complex coronary lesions.
- The pathophysiologic role of serotonin in human coronary syndromes remains undetermined.
Abstract:
Serotonin is released by activated platelets and may act as a mediator to initiate or sustain certain unstable syndromes of ischemic heart disease in humans. To determine whether or not serotonin concentration increases across the coronary bed in patients with severe, limiting angina, we measured central aortic and coronary sinus serotonin concentrations by a sensitive radioenzymatic assay in 39 patients with coronary artery disease and 13 patients with minimal or no coronary artery lesions as detected by arteriography. Although no difference existed in the mean aortic or coronary sinus serotonin concentrations between these two groups, elevated coronary sinus serotonin concentrations were detected in 23% of those with coronary artery disease. The coronary sinus and aortic serotonin concentration difference was greater in patients with significant coronary artery disease (0.6 +/- 6.62 ng/ml) compared with patients without significant coronary artery disease (-5.6 +/- 10.32 ng/ml) (mean +/- SD) (p less than 0.05). Further analysis revealed that patients with eccentric, irregular coronary artery lesions or intraluminal filling defects had a significantly elevated coronary sinus and aortic serotonin difference (3.1 +/- 5.54 ng/ml) compared with those with smooth concentric lesions (-1.9 +/- 6.61 ng/ml) (p less than 0.02). These data suggest that serotonin is released into the coronary circulation of some patients with coronary artery disease, especially those with frequent angina and complex coronary lesions. Although serotonin may be released in some patients with coronary artery disease, the specific pathophysiologic role of serotonin in the development or perpetuation of certain coronary syndromes in humans remains to be determined.