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Fatehi Hassanabad A, El-Sherbini AH, Cherif IA, Ahmad B, Gonzalez ALF, Pelletier M, Fedak P, El-Diasty M. Pericardial fluid troponin in cardiac surgery. Clin Chim Acta 2024; 559:119722. [PMID: 38734224 DOI: 10.1016/j.cca.2024.119722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Revised: 05/06/2024] [Accepted: 05/07/2024] [Indexed: 05/13/2024]
Abstract
BACKGROUND AND OBJECTIVE Pericardial Fluid (PF) is a rich reservoir of biologically active factors. Due to its proximity to the heart, the biochemical structure of PF may reflect the pathological changes in the cardiac interstitial environment. This manuscript aimed to determine whether the PF level of cardiac troponins changes in patients undergoing cardiac surgery. METHODS This scoping review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Medline, EMBASE, Cochrane, ClinicalTrials.gov, and Google Scholar databases were electronically searched for primary studies using the keywords "pericardial fluid," "troponin," and "cardiac surgery." The primary outcome of interest was changes in troponin levels within the PF preoperatively and postoperatively. Secondary outcomes of interest included comparisons between troponin level changes in the PF compared to plasma. RESULTS A total of 2901 manuscripts were screened through a title and abstract stage by two independent blinded reviewers. Of those, 2894 studies were excluded, and the remaining seven studies underwent a full-text review. Studies were excluded if they did not provide data or failed to meet inclusion criteria. Ultimately, six articles were included that discussed cardiac troponin levels within the PF in patients who had undergone cardiac surgery. Pericardial troponin concentration increased over time after surgery, and levels were significantly higher in PF compared to serum. All studies found that the type of operation did not affect these overall observations. CONCLUSION Our review of the literature suggest that the PF level of cardiac troponins increases in patients undergoing cardiac surgery, irrespective of the procedure type. However, these changes' exact pattern and clinical significance remain undefined.
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Affiliation(s)
- Ali Fatehi Hassanabad
- Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | | | | | - Basil Ahmad
- School of Medicine, Queen's University, Kingston, ON, Canada
| | | | - Marc Pelletier
- Division of Cardiac Surgery, University Hospitals Cleveland Medical Centre, Cleveland, OH, USA
| | - Paul Fedak
- Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Mohammad El-Diasty
- Faculty of Health Sciences, Queen's University, Kingston, ON, Canada; Division of Cardiac Surgery, University Hospitals Cleveland Medical Centre, Cleveland, OH, USA.
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El-Diasty MM, Rodríguez J, Pérez L, Eiras S, Fernández AL. Accumulation of Inflammatory Mediators in the Normal Pericardial Fluid. Int J Mol Sci 2023; 25:157. [PMID: 38203327 PMCID: PMC10779335 DOI: 10.3390/ijms25010157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 12/03/2023] [Accepted: 12/13/2023] [Indexed: 01/12/2024] Open
Abstract
There is paucity of studies that focus on the composition of pericardial fluid under resting conditions. The purpose of this study is to determine the levels of inflammatory mediators in pericardial fluid and their correlation with plasma levels in patients undergoing elective cardiac surgery. We conducted a prospective cohort study on candidates for elective aortic valve replacement surgery. Pericardial fluid and peripheral venous blood samples were collected after opening the pericardium. Levels of interleukin 1α (IL-1α); interleukin 1β (IL-1β); interleukin 2 (IL-2) interleukin 4 (IL-4); interleukin 6 (IL-6); interleukin 8 (IL8); interleukin 10 (IL10); tumor necrosis factor-α (TNF-α), interferon-γ (IFN-γ), vascular endothelial growth factor (VEGF), monocyte chemotactic protein-1 (MCP-1) epidermal growth factor (EGF), soluble E-selectin, L-selectin, P-selectin, intercellular adhesion molecule-1 (ICAM-1), and vascular cell adhesion molecule-1 (VCAM-1) were determined in both pericardial fluid and serum samples. A total of 45 patients with a mean age of 74 years were included of which 66% were males. Serum levels of all study mediators were within normal limits. Serum and pericardial levels of IL-1 α, IL-1 β, IL-2, IL-4, and IL-10 were similar. Levels of VEGF, EGF, VCAM-2, ICAM 1, E-selectin, P-selectin, and L-selectin were significantly lower in pericardial fluid than in serum. However, levels of IL-6, IL-8, TNF-α, IFN-γ, MCP-1, and MCP-1 were significantly higher in the pericardial fluid than in serum. Under normal conditions, the pattern of distribution of different inflammatory mediators in the pericardial fluid does not reflect serum levels. This may either reflect the condition of the underlying myocardium and epicardial fat or the activity of the mesothelial and mononuclear cells present in pericardial fluid.
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Affiliation(s)
- Mohammad M. El-Diasty
- Cardiac Surgery Department, Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, OH 44106, USA;
- Division of Clinical Biochemistry, University Hospital, 15706 Santiago de Compostela, Spain; (J.R.); (L.P.)
| | - Javier Rodríguez
- Division of Clinical Biochemistry, University Hospital, 15706 Santiago de Compostela, Spain; (J.R.); (L.P.)
| | - Luis Pérez
- Division of Clinical Biochemistry, University Hospital, 15706 Santiago de Compostela, Spain; (J.R.); (L.P.)
| | - Sonia Eiras
- Laboratory of Cardiovascular Research, University Hospital, 15706 Santiago de Compostela, Spain;
| | - Angel L. Fernández
- Division of Cardiac Surgery, University Hospital, Department of Surgery, University of Santiago de Compostela, 15706 Santiago de Compostela, Spain
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Goeddel LA, Zaky A, Aban I, Steele C, George JF, Melby SJ, Dell'Italia LJ. Feasibility study of intraoperative pericardial fluid biomarkers and length of stay after cardiac surgery. JTCVS Tech 2023; 19:86-92. [PMID: 37324339 PMCID: PMC10268501 DOI: 10.1016/j.xjtc.2023.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 03/21/2023] [Accepted: 03/29/2023] [Indexed: 06/17/2023] Open
Abstract
Objective Pericardial fluid biomarkers reflect the physiologic state of the myocardium. Previously, we showed a sustained increase in pericardial fluid biomarkers compared with blood in the 48 hours after cardiac surgery. We assess the feasibility of analyzing 9 common cardiac biomarkers from pericardial fluid collected during cardiac surgery and test a preliminary hypothesis of association between the most common biomarkers, troponin and brain natriuretic peptide, and length of stay after surgery. Methods We prospectively enrolled 30 patients aged 18 years or more undergoing coronary artery or valvular surgery. Patients with ventricular assist devices, atrial fibrillation surgery, thoracic aorta surgery, redo surgery, concomitant noncardiac surgery, and preoperative inotropic support were excluded. Before pericardial excision during surgery, a 1-cm pericardial incision was made to insert an 18-gauge catheter and collect 10 mL of pericardial fluid. Concentrations of 9 established biomarkers of cardiac injury or inflammation including brain natriuretic peptide and troponin were measured. Zero truncated Poisson regression adjusted for Society of Thoracic Surgery Preoperative Risk of Mortality tested for a preliminary association between pericardial fluid biomarkers and length of stay. Results Pericardial fluid was collected and pericardial fluid biomarkers resulted for all patients. Adjusted for Society of Thoracic Surgery risk, brain natriuretic peptide, and troponin were associated with increased intensive care unit and overall hospital length of stay. Conclusions In 30 patients, pericardial fluid was obtained and analyzed for cardiac biomarkers. Adjusting for Society of Thoracic Surgery risk, pericardial fluid troponin and brain natriuretic peptide were preliminarily associated with increased length of stay. Further investigation is needed to validate this finding and to investigate the potential clinical utility of pericardial fluid biomarkers.
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Affiliation(s)
- Lee A. Goeddel
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Ahmed Zaky
- Department of Anesthesiology, University of Alabama at Birmingham, Birmingham, Ala
| | - Inmaculada Aban
- Department of Biostatistics University of Alabama at Birmingham, Birmingham, Ala
| | - Chad Steele
- Department of Microbiology and Immunology, Tulane University School of Medicine
| | - James F. George
- Division of Cardiothoracic Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, Ala
| | | | - Louis J. Dell'Italia
- Department of Veterans Affairs Medical Center, Birmingham, Ala, Department of Medicine
- Division of Cardiovascular Disease
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An overview of human pericardial space and pericardial fluid. Cardiovasc Pathol 2021; 53:107346. [PMID: 34023529 DOI: 10.1016/j.carpath.2021.107346] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 05/11/2021] [Accepted: 05/12/2021] [Indexed: 12/24/2022] Open
Abstract
The pericardium is a double-layered fibro-serous sac that envelops the majority of the surface of the heart as well as the great vessels. Pericardial fluid is also contained within the pericardial space. Together, the pericardium and pericardial fluid contribute to a homeostatic environment that facilitates normal cardiac function. Different diseases and procedural interventions may disrupt this homeostatic space causing an imbalance in the composition of immune mediators or by mechanical stress. Inflammatory cells, cytokines, and chemokines are present in the pericardial space. How these specific mediators contribute to different diseases is the subject of debate and research. With the advent of highly specialized assays that can identify and quantify various mediators we can potentially establish specific and sensitive biomarkers that can be used to differentiate pathologies, and aid clinicians in improving clinical outcomes for patients.
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Filgueira CS, Igo SR, Wang DK, Hirsch M, Schulz DG, Bruckner BA, Grattoni A. Technologies for intrapericardial delivery of therapeutics and cells. Adv Drug Deliv Rev 2019; 151-152:222-232. [PMID: 30797957 DOI: 10.1016/j.addr.2019.02.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 02/13/2019] [Accepted: 02/15/2019] [Indexed: 12/12/2022]
Abstract
The pericardium, which surrounds the heart, provides a unique enclosed volume and a site for the delivery of agents to the heart and coronary arteries. While strategies for targeting the delivery of therapeutics to the heart are lacking, various technologies and nanodelivery approaches are emerging as promising methods for site specific delivery to increase therapeutic myocardial retention, efficacy, and bioactivity, while decreasing undesired systemic effects. Here, we provide a literature review of various approaches for intrapericardial delivery of agents. Emphasis is given to sustained delivery approaches (pumps and catheters) and localized release (patches, drug eluting stents, and support devices and meshes). Further, minimally invasive access techniques, pericardial access devices, pericardial washout and fluid analysis, as well as therapeutic and cell delivery vehicles are presented. Finally, several promising new therapeutic targets to treat heart diseases are highlighted.
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Elie AGIM, Bloksgaard M, Sun WY, Yang K, Man AWC, Xu A, Irmukhamedov A, Riber LP, Wang Y, De Mey JGR. Local enrichment of fatty acid-binding protein 4 in the pericardial cavity of cardiovascular disease patients. PLoS One 2018; 13:e0206802. [PMID: 30395653 PMCID: PMC6218069 DOI: 10.1371/journal.pone.0206802] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 10/19/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The pericardial fluid may be representative of the interstitium of the heart. The aim of this study was to discriminate in cardiovascular disease patients between adipocytokines that are produced locally by the heart and those supplied by the circulation. METHODS Enzyme-linked immunosorbent assays (ELISA) were used to determine levels of N-terminal pro-brain natriuretic peptide (NT-pBNP), fatty acid-binding protein 4 (FABP4), leptin, lipocalin-2, neutrophil elastase, proteinase-3, high sensitivity C-reactive protein (hsCRP) and adiponectin in venous plasma and pericardial fluid harvested during elective cardio-thoracic surgery (n = 132-152). RESULTS In pericardial fluid compared to plasma, the levels were significantly smaller (p < 0.001) for leptin, lipocalin-2, neutrophil elastase, proteinase-3, hsCRP and adiponectin. For these biomarkers, the ratio of pericardial fluid-to-plasma level ([PF]/[P], median (interquartile range)) was 0.65 (0.47-1.01), 0.78 (0.56-1.09), 0.23 (0.11-0.60), 0.17 (0.09-0.36), 0.14 (0.08-0.35), and 0.25 (0.15-0.34), respectively. In contrast, pericardial fluid was significantly enriched (p < 0.001) in NT-pBNP ([PF]/[P]: 1.9 (1.06-2.73)) and even more so for FABP4 ([PF]/[P]: 3.90 (1.47-9.77)). Moreover, in pericardial fluid, the adipocytokines interrelated all significantly positive and correlated negative to hsCRP, whereas for NT-pBNP only a significantly positive correlation with adiponectin was found. These interrelations were distinct from those in the plasma, as were the correlations of the pericardial biomarkers with patient characteristics compared to plasma. CONCLUSIONS In cardiovascular disease patients, the pericardial cavity is a distinct adipocytokine microenvironment in which especially FABP4 is mainly derived from the heart.
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Affiliation(s)
- Atlanta G. I. M. Elie
- Department of Cardiovascular and Renal Research, Institute of Molecular Medicine, University of Southern Denmark, Odense C, Denmark
| | - Maria Bloksgaard
- Department of Cardiovascular and Renal Research, Institute of Molecular Medicine, University of Southern Denmark, Odense C, Denmark
| | - Wai Y. Sun
- State Key Laboratory of Pharmaceutical Biotechnology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Kangmin Yang
- State Key Laboratory of Pharmaceutical Biotechnology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Andy W. C. Man
- State Key Laboratory of Pharmaceutical Biotechnology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Aimin Xu
- State Key Laboratory of Pharmaceutical Biotechnology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
- Department of Medicine, The University of Hong Kong, Hong Kong, China
| | - Akhmadjon Irmukhamedov
- Department of Cardiac, Thoracic and Vascular Surgery, Odense University Hospital, Odense C, Denmark
| | - Lars P. Riber
- Department of Cardiac, Thoracic and Vascular Surgery, Odense University Hospital, Odense C, Denmark
| | - Yu Wang
- State Key Laboratory of Pharmaceutical Biotechnology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Jo G. R. De Mey
- Department of Cardiovascular and Renal Research, Institute of Molecular Medicine, University of Southern Denmark, Odense C, Denmark
- Department of Cardiac, Thoracic and Vascular Surgery, Odense University Hospital, Odense C, Denmark
- * E-mail:
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Kiris I, Kapan S, Narin C, Ozaydın M, Cure MC, Sutcu R, Okutan H. Relationship between site of myocardial infarction, left ventricular function and cytokine levels in patients undergoing coronary artery surgery. Cardiovasc J Afr 2016; 27:299-306. [PMID: 27805242 PMCID: PMC5370381 DOI: 10.5830/cvja-2016-027] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Accepted: 03/08/2016] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The purpose of this study was to examine the relationship between left ventricular (LV) function, cytokine levels and site of myocardial infarction (MI) in patients undergoing coronary artery bypass grafting (CABG). METHODS Sixty patients undergoing CABG were divided into three groups (n = 20) according to their history of site of myocardial infarction (MI): no previous MI, anterior MI and posterior/inferior MI. In the pre-operative period, detailed analysis of LV function was done by transthoracic echocardiography. The levels of adrenomedullin, interleukin-1-beta, interleukin-6, tumour necrosis factor-alpha (TNF-α) and angiotensin-II in both peripheral blood samples and pericardial fluid were also measured. RESULTS Echocardiographic analyses showed that the anterior MI group had significantly worse LV function than both the group with no previous MI and the posterior/inferior MI group (p < 0.05 for LV end-systolic diameter, fractional shortening, LV end-systolic volume, LV end-systolic volume index and ejection fraction). In the anterior MI group, both plasma and pericardial fluid levels of adrenomedullin and and pericardial fluid levels of interleukin-6 and interleukin- 1-beta were significantly higher than those in the group with no previous MI (p < 0.05), and pericardial fluid levels of adrenomedullin, interleukin-6 and interleukin-1-beta were significantly higher than those in the posterior/inferior MI group (p < 0.05). CONCLUSIONS The results of this study indicate that (1) patients with an anterior MI had worse LV function than patients with no previous MI and those with a posterior/inferior MI, and (2) cytokine levels in the plasma and pericardial fluid in patients with anterior MI were increased compared to patients with no previous MI.
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Affiliation(s)
- Ilker Kiris
- Department of Cardiovascular Surgery, Medifema Private Hospital, Izmir, Turkey.
| | - Sahin Kapan
- Department of Cardiovascular Surgery, Medical Park Antalya Hospital, Antalya, Turkey
| | - Cuneyt Narin
- Department of Cardiovascular Surgery, Egepol Private Hospital, Izmir, Turkey
| | - Mehmet Ozaydın
- Department of Cardiology, Suleyman Demirel University Medical School, Isparta, Turkey
| | - Medine Cumhur Cure
- Department of Biochemistry, Recep Tayyip Erdogan University Medical School, Rize, Turkey
| | - Recep Sutcu
- Department of Biochemistry, Ataturk Education and Research Hospital, Katip Celebi University, Izmir, Turkey
| | - Huseyin Okutan
- Department of Cardiovascular Surgery, Medical Park Antalya Hospital, Antalya, Turkey
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Bildirici U, Celikyurt U, Ural D, Agacdiken A, Catakoglu B, Bulut O, Ural E. Brain natriuretic peptide and tumour markers in the diagnosis of non-malignant pericardial effusion. Int J Cardiol 2011; 146:481-3. [DOI: 10.1016/j.ijcard.2010.12.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2010] [Accepted: 12/04/2010] [Indexed: 11/16/2022]
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The epicardium in cardiac repair: From the stem cell view. Pharmacol Ther 2011; 129:82-96. [DOI: 10.1016/j.pharmthera.2010.09.002] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2010] [Accepted: 09/09/2010] [Indexed: 12/12/2022]
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Ciuraszkiewicz K, Janion M, Sielski J, Dudek D, Gawor Z. Post-myocardial infarction intraventricular conduction defects and B-type natriuretic peptide levels. Clin Cardiol 2009; 32:E12-7. [PMID: 19189316 PMCID: PMC6653500 DOI: 10.1002/clc.20296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2007] [Accepted: 09/07/2007] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Levels of B-type natriuretic peptide (BNP), a significant marker of left ventricular (LV) dysfunction, may provide information on the severity of heart failure in patients with intraventricular conduction defects (IVCD).The aim of this study was to measure serum BNP levels in post-myocardial infarction (MI) patients with IVCD. METHODS In 2004-2005 during standard follow-up at 6 mo after acute MI in 158 subjects, BNP was measured using an immunoenzymatic method. Of them, 126 patients had IVCD: 31, left bundle branch block (LBBB); 36, right bundle branch block (RBBB); 30, left anterior hemiblock (LAH); and 29, left posterior hemiblock (LPH). Thirty two patients with a previous MI, but without IVCD, served as controls, whereas 15 healthy subjects entered the comparative group. RESULTS In post-MI patients with IVCD, the mean BNP level was significantly higher than in their counterparts without IVCD (p < 0.001) and in healthy subjects (p < 0.001). The highest BNP level was found in patients with LBBB and RBBB. In patients with LAH and LPH, levels of BNP were insignificantly higher than in patients without IVCD. CONCLUSIONS Significantly higher BNP levels in patients with previous MI and IVCD suggest more severe heart failure than in their counterparts without IVCD with comparable LV ejection fraction.
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Affiliation(s)
| | - Marianna Janion
- Department of Cardiology, Świȩtokrzyskie Centrum Kardiologii
- Faculty of Health Sciences, Akademia Świȩtokrzyska, Kielce
| | - Janusz Sielski
- Department of Cardiology, Świȩtokrzyskie Centrum Kardiologii
| | - Dariusz Dudek
- Institute of Cardiology, Jagiellonian University Medical College of Krakow, Krakow
| | - Zenon Gawor
- Department of Internal Medicine, Nephrology and Dialysis Therapy, Medical University of Lodz, Lodz, Poland
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Watanabe M, Kawaguchi S, Nakahara H, Hachimaru T. The roles of natriuretic peptides in pericardial fluid in patients with heart failure. Clin Cardiol 2009; 32:159-63. [PMID: 19301292 DOI: 10.1002/clc.20306] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND It is well known that the plasma concentrations of atrial and brain natriuretic peptides, as cardiac hormones, are elevated in heart failure. HYPOTHESIS Pericardial fluid in patients with various heart diseases contains both natriuretic peptides that are released into the pericardial fluid. However, it is unknown whether these peptides reflect cardiac function in patients with various heart diseases, more than both the peptides in blood. METHODS Plasma and pericardial fluid samples were obtained from 22 patients undergoing cardiac surgery for the measurement of atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) levels in plasma and pericardial fluid. RESULTS The ANP levels in pericardial fluid were higher in patients with impaired left ventricular systolic function (ejection fraction<50% versus>or=50%; 77.0+/-4.9 versus 14.0+/-50.9, p=0.017), but not BNP.However, BNP levels in pericardial fluid were significantly higher in patients with left ventricle dilatation (left ventricular diastolic dimension<or=54 mm versus>54 mm; 130.3+/-68.9: 709.7+/-324.7, p=0.0168). Moreover, BNP levels in pericardial fluid were significantly higher in Grade III than Grade II and I (Grade I: echo-free space<5 mm, Grade II: 5-10 mm, Grade III: >10 mm). CONCLUSION These results suggest that BNP levels in pericardial fluid served as more sensitive and accurate indicators of left ventricular diastolic dysfunction, and that increased BNP levels in pericardial fluid may have an important pathophysiologic role in heart failure as a cardiocyte-derived antifibrotic factor.
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Affiliation(s)
- Masazumi Watanabe
- Department of Cardiovascular Surgery, Tokyo Metropolitan Hiroo General Hospital, Tokyo, Japan.
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Nakamura T, Azuma A, Sawada T, Sakamoto K, Yamano T, Yaku H, Matsubara H. Brain natriuretic peptide concentration in pericardial fluid is independently associated with atrial fibrillation after off-pump coronary artery bypass surgery. Coron Artery Dis 2007; 18:253-8. [PMID: 17496488 DOI: 10.1097/mca.0b013e328089f1b4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Postoperative atrial fibrillation is associated with the increased incidence of morbidities and mortality. Predisposing determinants of atrial fibrillation development after off-pump coronary artery bypass grafting remain unclear. We hypothesized that pericardial fluid natriuretic peptide concentrations have a predictive value for developing postoperative atrial fibrillation in patients who have undergone off-pump coronary artery bypass grafting. METHODS We prospectively measured atrial natriuretic peptide and brain natriuretic peptide concentrations in plasma and pericardial fluid in 42 consecutive patients undergoing off-pump coronary artery bypass grafting, then continuously observed the occurrence of atrial fibrillation following off-pump coronary artery bypass grafting until the time of discharge. RESULTS Postoperative atrial fibrillation was documented in nine patients (21%, atrial fibrillation group), and not in 33 patients (no atrial fibrillation group). Between the groups, there was neither significant difference in plasma atrial natriuretic peptide concentrations nor in pericardial atrial natriuretic peptide concentrations. Plasma brain natriuretic peptide concentrations were comparable in both groups [56.2 (interquartile range 42.7-102.8) vs. 35.2 pg/ml (13.8-75.0), P=0.07]. Pericardial fluid brain natriuretic peptide concentrations were significantly higher in the atrial fibrillation group than in the no atrial fibrillation group [188.0 (124.8-411.0) vs. 39.3 pg/ml (10.0-88.4), P=0.0001]. In a multivariable logistic regression model, pericardial brain natriuretic peptide concentration was significantly associated with a higher risk of postoperative atrial fibrillation (odds ratio=3.0 every 50 pg/ml increase; 95% confidence interval, 1.1-8.6; P=0.04). CONCLUSION Our results suggested that pericardial fluid brain natriuretic peptide concentration is independently associated with the development of atrial fibrillation after off-pump coronary artery bypass grafting.
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Affiliation(s)
- Takeshi Nakamura
- Department of Cardiovascular Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan.
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Chen LP, Wei TM, Wang LX. Relationship between Pericardial Fluid B-type Natriuretic Peptide and Ventricular Structure and Function. Arch Med Res 2007; 38:326-9. [PMID: 17350484 DOI: 10.1016/j.arcmed.2006.12.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2006] [Accepted: 12/06/2006] [Indexed: 10/23/2022]
Abstract
BACKGROUND We undertook this study to investigate the levels of pericardial B-type natriuretic peptide (BNP) and its relationship with ventricular structure and function. METHODS Pericardial and plasma BNP concentrations were measured in 18 patients with congenital ventricular septal defect. RESULTS The mean level of BNP in the pericardial fluid (324.8+/-137.3 pg/mL) was higher than the plasma (20.8+/-6.1 pg/mL) (p=0.03). Pericardial BNP was correlated with the plasma BNP (r=0.85, p<0.01). A good correlation was also found between the pericardial BNP and left atrial diameter, left ventricular end-diastolic and end-systolic diameter, left ventricular ejection fraction, right ventricular diameter and pulmonary artery systolic pressure (p<0.05). CONCLUSIONS The levels of BNP in pericardial fluid were higher than in the plasma. Similar to plasma BNP, pericardial BNP is also related to the ventricular structure and function.
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Affiliation(s)
- Li-Ping Chen
- Department of Cardiology, Lishui City Central Hospital, Wenzhou Medical College, Lishui, the People's Republic of China
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Zhu BL, Ishikawa T, Michiue T, Li DR, Zhao D, Tanaka S, Kamikodai Y, Tsuda K, Okazaki S, Maeda H. Postmortem pericardial natriuretic peptides as markers of cardiac function in medico-legal autopsies. Int J Legal Med 2006; 121:28-35. [PMID: 16741745 DOI: 10.1007/s00414-006-0102-1] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2006] [Accepted: 04/24/2006] [Indexed: 11/29/2022]
Abstract
Atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) in the blood are clinical markers for the diagnosis of cardiac failure. This study was a comprehensive analysis of the postmortem pericardial levels of the natriuretic peptides in serial medico-legal autopsy cases (n=263, within 72 h postmortem) to assess their validity in investigating cardiac function. There was no significant relationship of pericardial ANP or BNP levels with postmortem time or the age of the subjects. The ANP and BNP levels showed negative correlations with the pericardial cardiac troponin T level. The ANP level was significantly elevated in drowning cases. Pericardial BNP and the BNP/ANP ratio were significantly higher for chronic congestive heart disease. However, asphyxiation, sharp instrument injury, hyperthermia, and fatal MA poisoning cases showed lower levels for both markers. These observations suggest that elevations in the postmortem pericardial ANP and BNP may mainly depend on acute atrial overload and subacute or chronic cardiac failure, respectively, and may be reduced by advanced myocardial damage.
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Affiliation(s)
- Bao-Li Zhu
- Department of Legal Medicine, Osaka City University Medical School, Asahi-machi 1-4-3, Abeno, Osaka, 545-8585, Japan.
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Seres L, Soós P, Székely M, Horkay F, Selmeci L. Antioxidant capacity of the human pericardial fluid: does gender have a role? Clin Chem Lab Med 2004; 42:952-7. [PMID: 15387449 DOI: 10.1515/cclm.2004.155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The aim of the present study was to assess the antioxidant capacity in the serum and pericardial fluid of patients undergoing heart surgery for coronary heart disease (CHD) or valvular heart disease (VHD) and to find out whether there are gender-related differences in the antioxidant defense. This study involved 85 patients (35 VHD and 50 CHD) undergoing elective heart surgery. Blood samples from the peripheral vein and from the pericardial fluid were taken intraoperatively. Variables determined in the serum and pericardial fluid were: total protein, albumin, uric acid and antioxidant capacity. In the total patient population the antioxidant capacity in the pericardial fluid was lower than in the serum but still relatively high as determined by two independent techniques. No major differences were seen in serum or pericardial fluid antioxidant capacity between the two patient groups. In the overall patient population uric acid (p<0.05), albumin (p<0.01) and total protein concentrations (p<0.01) were, however, significantly greater in the pericardial fluid of male than of female patients. The pericardial fluid may contribute to the local antioxidant defense of the myocardium. It appears that male gender confers advantage in this respect. It remains to be elucidated whether this finding has any implication for the higher risk for women of perioperative complications and of cardiovascular mortality after coronary bypass grafting or coronary angioplasty.
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Affiliation(s)
- Leila Seres
- Department of Cardiovascular Surgery, Semmelweis University Faculty of Medicine, Budapest, Hungary
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17
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Ootaki Y, Yamaguchi M, Yoshimura N, Oka S, Yoshida M, Hasegawa T. Secretion of A-type and B-type natriuretic peptides into the bloodstream and pericardial space in children with congenital heart disease. J Thorac Cardiovasc Surg 2003; 126:1411-6. [PMID: 14666013 DOI: 10.1016/s0022-5223(03)01020-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To determine the secretion of A-type and B-type natriuretic peptides into the bloodstream and pericardial space in children with congenital heart disease. METHODS Plasma and pericardial fluid samples were obtained from 77 patients undergoing total correction for congenital heart disease. All patients underwent detailed right-sided and left-sided cardiac catheterization preoperatively. RESULTS A-type natriuretic peptide levels in pericardial fluid were lower than those in plasma (33.0 +/- 23.1 versus 39.8 +/- 33.6 pg/mL, P <.05), and B-type natriuretic peptide levels in pericardial fluid showed marked elevations compared with those in plasma (231.9 +/- 305.6 versus 19.8 +/- 29.3 pg/mL, P <.0001). The A-type and B-type natriuretic peptide levels in plasma correlated with those in pericardial fluid (R =.522, P <.0001; R =.595, P <.0001). For A-type and B-type natriuretic peptide levels in plasma, the relation with biventricular volume had the highest correlation (R =.669, P <.0001; R =.652, P <.0001). The patients with a pulmonary-to-systemic flow ratio greater than 2 (n = 19) had high levels of natriuretic peptides not only in plasma (58.3 +/- 43.2, 40.5 +/- 49.4 pg/mL, P <.05) but also in pericardial fluid (44.4 +/- 31.5, 287.2 +/- 198.5 pg/mL, P <.05), and higher correlation between A-type and B-type natriuretic peptide plasma levels and left ventricular volume (R =.913, P <.0001; R =.787, P <.0001). CONCLUSIONS B-type natriuretic peptide is secreted not only into the bloodstream but also into the pericardial space in children with congenital heart disease. Natriuretic peptide levels in plasma correlated well with biventricular volume. The left ventricle was considered to be the main source of secreted natriuretic peptides in the patients with a pulmonary-to-systemic flow ratio greater than 2.
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Affiliation(s)
- Yoshio Ootaki
- Department of Cadiothoracic Surgery, Kobe's Children Hospital, Hyogo, Japan.
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Soós P, Juhász-Nagy A, Ruskoaho H, Hartyánszky I, Merkely B, Tóth M, Horkay F. Locally different role of atrial natriuretic peptide (ANP) in the pericardial fluid. Life Sci 2002; 71:2563-73. [PMID: 12270761 DOI: 10.1016/s0024-3205(02)02088-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Pericardial fluid (PF) contains several vasoactive agents in higher concentrations than venous plasma (VP). However, with human atrial natriuretic peptide (ANP) controversial data have been reported in earlier studies performed on a limited number of patients (less than 20). The present study was designed to characterize the ANP levels in human PF and cardiac tissues, and to ascertain whether myocardial ischemic state is a major factor in determining ANP production of the human heart. In a total of 316 consecutive patients undergoing open heart surgery ANP levels in VP, PF, atrial and ventricular tissues were measured by radioimmunoassay and analyzed by high-performance liquid chromatography (HPLC). The data are presented as median and 25th-75th percentiles. Our results showed ANP concentration [ANP] of PF significantly exceeded that of VP and [ANP] in the atrial tissue was significantly higher than in the ventricular tissue (p < 0.001). In patients without myocardial ischemia (valvular heart disease) [ANP] in the PF was 258.3 (189.9-342.5) pg/ml, in the VP 28.4 (11.7-57.6) pg/ml and 151.7 (78.4-447.6) ng/mg in the atrial, 0.4 (0.2-1.6) ng/mg in the ventricular tissue. The corresponding values for patients with coronary artery disease were 208.1 (153.8-318.9) pg/ml in the PF, 19.8 (9.4-27.9) pg/ml in the VP, 129.6 (66.5-455.0) ng/mg in the atrial and 1.0 (0.1-1.8) ng/mg in the ventricular tissue. The ventricular tissue levels correlated to the atrial tissue levels (r = 0.317; p < 0.05). Great difference (p < 0.001) was found in the atrial tissue levels between females [414.6 (119.7-734.4) ng/mg] and males [105.4 (65.3-204.2) ng/mg]. In HPLC analysis the majority of the pericardial fluid and tissue ir-ANP coeluted with human ANP [99-126]. In conclusion, [ANP] in PF of cardiosurgical patients is higher by an order of magnitude than in VP. Intrapericardial ANP may reflect the peptide concentration in the myocardial interstitium and may represent a paracrine regulatory mechanism, which seems independent of ANP-induced putative antiischemic influences.
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Affiliation(s)
- Pál Soós
- Department of Cardiovascular Surgery, Semmelweis University Budapest, Hungary.
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