RELEASE OF ADENOSINE FROM HUMAN HEARTS DURING ANGINA INDUCED BY RAPID ATRIAL-PACING
RELEASE OF ADENOSINE FROM HUMAN HEARTS DURING ANGINA INDUCED BY RAPID ATRIAL-PACING
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DOI：
10.1172/jci107693
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发表时间：
1974-01-01
影响因子：
15.9
通讯作者：
SILK, BB
中科院分区：
文献类型：
--
作者：
FOX, AC;REED, GE;SILK, BB
这项研究旨在确定人类心脏是否释放腺苷，一种可能的冠状动脉流量的调节剂，在暂时性心肌缺血，如果是这样，检查所涉及的机制。在短暂冠状动脉闭塞后的反应性充血期间，曾有报道称犬心脏释放腺苷，我们最初在6只犬心脏中证实了这一观察结果。然后在诊断研究期间通过快速心房起搏对15名患有心绞痛综合征和严重冠状动脉粥样硬化的患者产生心绞痛。其中13例患者的冠状窦血中出现腺苷，平均水平为40 nmol/100 ml血液（SE = ±9）。在这13例患者中，有11例在对照或恢复期样本中未检测到腺苷;测量时，伴随着乳酸盐的产生和最小的K+渗漏，但没有显著的肌酸磷酸激酶、乳酸脱氢酶、肌酸或Na+释放。在三组对照患者中，在起搏或运动期间心脏未检测到腺苷释放：9名患有心绞痛综合征和严重冠状动脉粥样硬化，在快速起搏过程中没有发生心绞痛或产生乳酸，5名冠状动脉正常，没有心肌疾病，3例冠状动脉正常但左心室衰竭，结果表明，在严重的局部心肌梗塞时，缺血和无氧代谢。腺苷释放可作为缺血对心肌代谢早期影响的一个有用的补充指标，并可能影响心绞痛期间或之后的局部冠状动脉血流。
This study was designed to determine whether human hearts release adenosine, a possible regulator of coronary flow, during temporary myocardial ischemia and, if so, to examine the mechanisms involved. Release of adenosine from canine hearts had been reported during reactive hyperemia following brief coronary occlusion, and we initially confirmed this observation in six dogs hearts. Angina was then produced in 15 patients with anginal syndrome and severe coronary atherosclerosis by rapid atrial pacing during diagnostic studies. In 13 of these patients, adenosine appeared in coronary sinus blood, at a mean level of 40 nmol/100 ml blood (SE = ±9). In 11 of these 13, adenosine was not detectable in control or recovery samples; when measured, there was concomitant production of lactate and minimal leakage of K+, but no significant release of creatine phosphokinase, lactic acid dehydrogenase, creatine, or Na+.There was no detectable release of adenosine by hearts during pacing or exercise in three control groups of patients: nine with anginal syndrome and severe coronary atherosclerosis who did not develop angina or produce lactate during rapid pacing, five with normal coronaries and no myocardial disease, and three with normal coronaries but with left ventricular failure.The results indicate that human hearts release significant amounts of adenosine during severe regional myocardial ischemia and anaerobic metabolism. Adenosine release might provide a useful supplementary index of the early effects of ischemia on myocardial metabolism, and might influence regional coronary flow during or after angina pectoris.