P421In the pericardial fluid (PF) increased levels of troponin-I and macrophage migration inhibitory factor (MIF) indicate myocardial ischemia and proinflammation

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Abstract

Purpose

The physiological role of pericardial fluid (PF) is to reduce the mechanical friction between the pericardium and the heart. PF is an ultrafiltrate of blood plasma; however, some of its components are released from the cardiac interstitium. In the clinical practice, the composition of PF in patients with valve replacement is regarded as physiological. We hypothesized that the composition of the PF reflects the pathophysiological changes in the cardiac muscle that take place during coronary heart disease, such as hypoxia/ischemia.

Methods

Human serum and PF samples were collected during coronary artery bypass graft (CABG, n=23) and valve replacement (VR, n=13) surgery than were analyzed.

Results

Phosphate, lactate, creatinin-kinase, LDH, albumin, protein content and renin activity of PF were significantly decreased (p < 0.05) compared to those of serum in both CABG and VR patients. Protein content in CABG-PF 17 ± 2mmol/L, serum: 45 ± 3mmol/L, VR-PF: 21 ± 2mmol/L, serum: 41 ± 3mmol/L. LDH: in CABG-PF 48 ± 11U/L, in serum: 186 ± 12U/L; in VR-PF 56 ± 14U/L, in serum: 185 ± 17U/L. Creatinin-kinase in CABG-PF 4 ± 1U/L, in serum: 40 ± 4U/L, in VR-PF: 5 ± 1U/L, in serum: 65 ± 28U/L. Renin activity in CABG-PF: 0.2 ± 0.2ng/mL/h, in serum: 24 ± 7ng/mL/h, in VR-PF: 0.04 ± 0.02ng/mL/h, in serum: 10.4 ± 4ng/mL/h. Serum troponin-I both in VR and in CABG patients were below the ischemic level ( < 40 pg/mL). PF troponin-I was significantly higher in both CABG (80 ± 20pg/mL) and VR (150 ± 40pg/mL) patient than the serum level. Macrophage migration inhibitory factor (MIF) in CABG-PF: 32.6 ± 5ng/mL, in serum: 3.9 ± 0.5ng/mL, in VR-PF: 16.5 ± 4ng/mL, in serum: 3.8 ± 1ng/mL. The MIF levels in serum were in the basal level (3-5ng/mL) in both VR and in CABG patients. PF MIF level was significantly higher in CABG (33 ± 5ng/mL) and VR (16.5 ± 4ng/mL) patients than the serum level (CABG: 3.9 ± 0.5ng/mL, VR: 3.8 ± 1ng/mL). PF MIF was significantly higher in CABG than in VR patients.

Conclusions

These results suggest that 1) the high level of troponin-I in the PF is a more sensitive marker of ischemia than that of serum, 2) in VR and CABG patients the high level of troponin-I in PF indicates progressed myocardial injury/ischemia. 3) The high MIF level in PF, especially in CABG, could be an early indicator of pro-inflammatory processes. Analyzing the composition of PF could help to understand novel aspects of myocardial dysfunction and develop new therapeutic modalities.

Conclusions

(Support:AHA-FA 0855910D, Hungarian Sci.Res. Funds/OTKA K71591 and K67984)

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