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Adenosine and Myocardial Protection in Humans

  • Robert M. MentzerJr.
  • Robert D. Lasley
Chapter
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Part of the Developments in Cardiovascular Medicine book series (DICM, volume 194)

Abstract

The purine nucleoside adenosine appears to exert similar cardiovascular effects in humans as it does in most laboratory animal species. These include coronary and systemic vasodilation,1,2 renal vasoconstriction,3,4 slowing of atrial-ventricular (AV) conduction, 5,6 inhibition of norepinephrine release from sympathetic nerves,7 and inhibition of platelet aggregation.8,9 These properties provide the basis for the current use of adenosine in the clinical arena to diagnose and treat supravenrricular arrhythmias and enhance radionuclide perfusion imaging scans. Intravenous adenosine has also been used in humans after cardiac surgery to control postoperative systemic and pulmonary hypertension.10,11 Recent reports also indicate that systemic adenosine infusion reduces pain and the requirements for various anesthetics.12 These findings indicate that adenosine can be administered safely to patients.

Keywords

Ischemic Precondition Coronary Artery Bypass Surgery Myocardial Protection Adenosine Infusion Ischaemic Precondition 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 1.
    Wilson RF, Wyche K, Christensen BV et al. Effects of adenosine on human coronary arterial circulation. Circulation 1990;82:1595–606.PubMedCrossRefGoogle Scholar
  2. 2.
    Edlund A, Sollevi A, Linde B. Haemodynamic and metabolic effects of infused adenosine in man. Clin Science 1990;79:131–8.Google Scholar
  3. 3.
    Edlund A, Sollevi A. Renal effects of i.v. adenosine infusion in humans. Clin Physiol 1993;13:361–71.PubMedCrossRefGoogle Scholar
  4. 4.
    Marraccini P, Fedele S, Marzilli M et al. Adenosine-induced renal vasoconstriction in man. Cardiovasc Res 1996;32:949–953.PubMedGoogle Scholar
  5. 5.
    Conti JB, Belardinelli L, Utterback DB et al. Endogenous adenosine is an antiarrhythmic agent. Circulation 1995;91:1761–7.PubMedCrossRefGoogle Scholar
  6. 6.
    Bertolet BD, Belardinelli L, Franco EA et al. Selective attenuation by N-0861 (N-6-endonorboran-2-YL-9-methyladenine) of cardiac A(l) adenosine receptor-mediated effects in humans. Circulation 1996;93:1871–1876.PubMedCrossRefGoogle Scholar
  7. 7.
    Rongen GA, Lenders JWM, Lambrou J et al. Presynaptic inhibition of norepinephrine release from sympathetic nerve endings by endogenous adenosine. Hypertension 1996;27:933–938.PubMedCrossRefGoogle Scholar
  8. 8.
    Soderback U, Sollevi A, Wallen NH et al. Anti-aggregatory effects of physiological concentrations of adenosine in human whole blood as assessed by filtragometry. Clin Sci 1991;81:691–4.PubMedGoogle Scholar
  9. 9.
    Mentzer RM, Rahko PS, Canver CC et al. Adenosine reduces postbypass transfusion requirements in humans after heart surgery. Ann Surgery 1996;224:523–529.CrossRefGoogle Scholar
  10. 10.
    Owall A, Ehrenberg J, Brodin LA et al. Effects of low-dose adenosine on myocardial performance after coronary artery bypass surgery. Acta Anaesthesiol Scand 1993;37:140–148.PubMedCrossRefGoogle Scholar
  11. 11.
    Fullerton DA, Jones SD, Grover FL et al. Adenosine effectively controls pulmonary hypertension after cardiac operations. Ann Thorac Surg 1966;61:1118–1123.CrossRefGoogle Scholar
  12. 12.
    Segerdahl M, Ekblom A, Sandelin K et al. Peroperative adenosine infusion reduces the requirements for isoflurane and postoperative analgesics. Anesth Analg 1995;80:1145–9.PubMedGoogle Scholar
  13. 13.
    Speechly-Dick ME, Grover GJ, Yellon DM. Does ischemic preconditioning in the human involve protein kinase C and the ATP-dependent K+ channel? Studies of contractile function after simulated ischemia in an atrial in vitro model. Circ Res 1995;77:1030–5.PubMedCrossRefGoogle Scholar
  14. 14.
    Walker DM, Walker JM, Pugsley WB et al. Preconditioning in isolated superfused human muscle. J Mol Cell Cardiol 1995;27:1349–57.PubMedCrossRefGoogle Scholar
  15. 15.
    Bohm M, Pieske B, Ungerer M et al. Characterization of Al adenosine receptors in atrial and ventricular myocardium from diseased human hearts. Circ Res 1989;65:1201–11.PubMedCrossRefGoogle Scholar
  16. 16.
    Utterback DB, Staples ED, White SE et al. Basis for the selective reduction of pulmonary vascular resistance in humans during infusion of adenosine. J Appl Physiol 1994;76:724–30.PubMedGoogle Scholar
  17. 17.
    Lee HT, Lafaro RJ, Reed GE. Pretreatment of human myocardium with adenosine during open heart surgery. J Cardiac Surg 1995;10:665–676.CrossRefGoogle Scholar
  18. 18.
    Fremes SE, Levy SL, Christakis GT et al. Phase 1 human trial of adenosine-potassium cardioplegia. Circulation 1996;94(Suppl II):370–375.Google Scholar
  19. 19.
    Mentzer RM, Rahko PS, Molina-Viamonte V et al. Safety, tolerance, and efficacy of adenosine as an additive to blood cardioplegia in humans during coronary artery bypass surgery. Int J Cardiol (In Press), 1997.Google Scholar
  20. 20.
    Feldman MD, Ayers CR, Lehman MR et al. Improved detection of ischemia-induced increases in coronary sinus adenosine in patients with coronary artery disease. Clin Chem 1992;38:256–62.PubMedGoogle Scholar
  21. 21.
    Nissinen J, Raatikainen MJ, Karlqvist K et al. Efflux of adenosine and its catabolites during cold blood cardioplegia. Ann Thorac Surg 1993;55:1546–52.PubMedCrossRefGoogle Scholar
  22. 22.
    Vlessis AA, Ott G, Cobanoglu A. Purine efflux from transplanted human cardiac allografts. Correlation with graft function. J Thorac Cardiovasc Surg 1994;107:482–6.PubMedGoogle Scholar
  23. 23.
    Deutsch E, Berger M, Kussmaul WG et al. Adaptation to ischemia during percutaneous transluminal coronary angioplasty: clinical, hemodynamic, and metabolic features. Circulation 1990;82:2044–2051.PubMedCrossRefGoogle Scholar
  24. 24.
    Inoue T, Fujito T, Hoshi K. et al.A mechanism of preconditioning during percutaneous transluminal coronary angioplasty. Cardiology 1996;87:216–223.PubMedCrossRefGoogle Scholar
  25. 25.
    Kerensky RA, Kutcher MA, Braden GA et al.The effects of intracoronary adenosine on preconditioning during coronary angioplasty. Clin Cardiol 1995;18:91–96.PubMedCrossRefGoogle Scholar
  26. 26.
    Pasini FL, Guideri F, Ferber D et al. Pharmacological preconditioning of ischemic heart disease by low-dose dipyridamole. Int J Cardiol 1996;56:17–27.PubMedCrossRefGoogle Scholar
  27. 27.
    Strauer BE, Heidland UE, Heintzen MP et al. Pharmacologic myocardial protection during percutaneous transluminal coronary angioplasty by intracoronary application of dipyridamole-impact on hemodynamic function and left ventricular performance. J Am Coll Cardiol 1996;28:1119–1126.PubMedCrossRefGoogle Scholar
  28. 28.
    Claeys MJ, Vrints CJ, Bosmans JM et al. Aminophylline inhibits adaptation to ischaemia during angioplasty-role of adenosine in ischaemic preconditioning. Eur Heart J 1996;17:539–544.PubMedCrossRefGoogle Scholar
  29. 29.
    Tomai F, Crea F, Gaspardone A et al. Effects of A(l) adenosine receptor blockade by bamiphylline on ischaemic preconditioning during coronary angioplasty Eur Heart J 1996;17:846–853.PubMedCrossRefGoogle Scholar
  30. 30.
    Ottani F, Galvani M, Ferriai D et al. Prodromal angina limits infarct size: A role for ischemic preconditioning. Circulation 1995;91:291–297.PubMedCrossRefGoogle Scholar
  31. 31.
    Ottani F, Galvani M, Ferrini D et al. Prodromal angina limits infarct size. A role for ischemic preconditioning. Circulation 1995;91:291–7.PubMedCrossRefGoogle Scholar
  32. 32.
    Kloner RA, Shook T, Przyklenk K et al. Previous angina alters in-hospital outcome in TIMI 4: A clinical correlate to preconditioning? Circulation 1995;91:37–45.PubMedCrossRefGoogle Scholar
  33. 33.
    Alkhulafi AM, Yellon DM, Pugsley WB. Preconditioning the human heart during aortocoronary bypass surgery. Eur J Cardiothorac Surg 1994;8:270–275.CrossRefGoogle Scholar
  34. 34.
    Di Salvo C, Hemming A, Jenkins D et al. Can the human myocardium be preconditioned with ischaemia under hypothermic conditions? Proc Eur Assoc Cardiothorac Surg Paris September 25–7,1995:324.Google Scholar
  35. 35.
    Perrault LP, Menasche P, Bel A et al. Ischemic preconditioning in cardiac surgery-a word of caution. J Thorac Cardiovasc Surg 1996;112:1378–1386.PubMedCrossRefGoogle Scholar
  36. 36.
    Goto M, Cohen MV, VanWylen DGL et al. Attenuated purine production during subsequent ischemia in preconditioned rabbit myocardium is unrelated to the mechanism of protection. J Mol Cell Cardiol 1996;28:447–454.PubMedCrossRefGoogle Scholar
  37. 37.
    Cave AC, Garlick PB. Ischemic preconditioning and intracellular pH-a P-31 NMR study in the isolated rat heart. Am J Physiol 1997;41:H544–H552.Google Scholar
  38. 38.
    Ovize M, Przyklenk K, Hale SL et al. Preconditioning does not attenuate myocardial stunning. Circulation 1992;85:2247–54.PubMedCrossRefGoogle Scholar
  39. 39.
    Miyamae M, Fujiwara H, K.ida M et al. Preconditioning improves energy metabolism during reperfusion but does not attenuate myocardial stunning in porcine hearts. Circulation 1993;88:223–34.PubMedCrossRefGoogle Scholar
  40. 40.
    Jenkins DP, Pugsley WB, Yellon DM. Ischaemic preconditioning in a model of global ischaemia: infarct size limitation, but no reduction of stunning. J Mol Cell Cardiol 1995;27:1623–32.PubMedCrossRefGoogle Scholar
  41. 41.
    Cave AC, Hearse DJ. Ischaemic preconditioning and contractile function: studies with normothermic and hypothermic global ischaemia. J Mol Cell Cardiol 1992;24:1113–1123.PubMedCrossRefGoogle Scholar
  42. 42.
    Kolocassides KG, Galinanes M, Hearse DJ. Ischemic preconditioning, cardioplegia or both? Differing approaches to myocardial and vascular protection. J Mol Cell Cardiol 1996;28:623–634.PubMedCrossRefGoogle Scholar
  43. 43.
    Valen G, Takeshima S, Vaage J. Preconditioning improves cardiac function after global ischemia, but not after cold cardioplegia. Ann Thorac Surg 1996;62:1397–1403.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 1997

Authors and Affiliations

  • Robert M. MentzerJr.
  • Robert D. Lasley

There are no affiliations available

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