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Pericardial fluid adenosine in ischemic and valvular heart disease
A G Driver1, C A Kukoly, P A Spence
1Department of Medicine, East Carolina University School of Medicine, Greenville, NC 27858.
Insights
In patients with coronary artery disease, pericardial fluid adenosine concentrations were significantly elevated, suggesting increased adenosine release during myocardial ischemia. This finding supports adenosine
Area of Science:
- Cardiology
- Biochemistry
Background:
- Adenosine, released by ischemic myocardial cells, promotes coronary artery vasodilation.
- Pericardial fluid adenosine levels are studied in animal models of myocardial ischemia.
Purpose of the Study:
- To investigate whether pericardial fluid adenosine concentrations increase in human ischemic heart disease.
- To compare adenosine levels in patients with coronary artery disease versus valvular heart disease.
Main Methods:
- Adenosine concentrations were measured in pericardial fluid from 23 patients with coronary artery disease and 20 patients with valvular heart disease undergoing open-heart surgery.
- Pleural fluid adenosine levels were also measured during internal mammary artery bypass grafting.
Main Results:
- Pericardial fluid adenosine concentrations were significantly higher in patients with coronary artery disease (2.47 +/- 0.24 microM) compared to those with valvular heart disease (1.36 +/- 0.21 microM).
- Adenosine levels were higher in pleural fluid than pericardial fluid from the same individuals.
- Adenosine concentrations correlated significantly with pericardial fluid cell counts and lactate dehydrogenase levels.
Conclusions:
- Elevated pericardial fluid adenosine in coronary artery disease is consistent with myocardial adenosine release.
- Sufficient adenosine is present to potentially activate adenosine receptors in coronary artery smooth muscle.
Abstract:
Adenosine released by ischemic myocardial cells stimulates coronary artery vasodilation. Measurement of adenosine concentrations in pericardial fluid in animal models of myocardial ischemia has been used to study the process of adenosine release. To determine whether pericardial fluid adenosine concentrations are increased in human ischemic heart disease, adenosine concentrations were measured in pericardial fluid in 23 subjects undergoing open-heart surgery for coronary artery disease. The results were compared with adenosine concentrations measured in pericardial fluid obtained from 20 subjects undergoing surgery for valvular heart disease. Adenosine concentrations also were measured in pleural fluid obtained during internal mammary artery bypass grafting. Adenosine concentrations were significantly increased in subjects with coronary artery disease compared with fluid obtained from subjects with valvular heart disease (2.47 +/- 0.24 vs 1.36 +/- 0.21 [SEM] microM [p = 0.0013]). Adenosine concentrations were higher in pleural fluid than pericardial fluid from the same individuals. Adenosine concentrations were significantly correlated with pericardial fluid cell counts and lactate dehydrogenase concentrations (r = 0.48; p = 0.0012 and r = 0.77, p = 0.0001, respectively). The results are consistent with myocardial release of adenosine in ischemic heart disease. If adenosine concentrations in pericardial fluid approximate those in myocardial interstitial fluid, sufficient adenosine is present to stimulate adenosine receptor activation in coronary artery smooth muscle.