Different secretion patterns of two molecular forms of cardiac adrenomedullin in pressure- and volume-overloaded human heart failure
Toshio NishikimiH AsakawaHiroshi IidaYasushi MatsushitaIkuko ShibasakiKazuyoshi TadokoroYosuke MoriHideaki MoriYoshihiko MochizukiYoshitaka OkamuraShinichiro MiyoshiKenji KangawaHiroaki Matsuoka
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Adrenomedullin
Pericardial fluid
Ventricular pressure
The pericardium forms a continuous sac around the heart, analogous to the pleura surrounding the lungs, and the peritoneum surrounding the abdominal viscera. Between the parietal and visceral layers of the serous pericardium is the pericardial space, which normally contains a small volume of pericardial fluid. The clinical spectrum of pericardial diseases can be divided into: pericarditis, caused by acute inflammation; pericardial effusion, or fluid accumulation in the pericardial space, leading to tamponade; and constrictive pericarditis, caused by chronic infiltration or inflammation leading to pericardial constriction.
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We report a new, nonsurgical technique for obtaining multiple pericardial biopsies in patients with pericardial effusion. A short catheter is introduced by the Seldinger technique under fluoroscopy through the subxiphoid approach. The pericardial fluid is aspirated and the catheter replaced by an 8F teflon sheath with a curved tip. A bioptome is inserted through the sheath, and air is allowed to enter the pericardium. This method outlines the parietal percardium. The curved sheath directs the bioptome to the left or right wall. Eighteen consecutive patients had an average of eight pieces of pericardium removed. On histological examination, three patients had malignancy. Six had tuberculous granuloma, and mycobacterium tuberculosis was cultured from all six tissue specimens but only once from the fluid. Tissue smears showed acid fast bacilli in four out of six, whereas the fluid was negative in all. The biopsy yielded diagnostic information in nine out of ten patients with a thickened pericardium. There were no complications.
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To evaluate pericardial endothelin (ET) secretion by the human pericardial mesothelial cells.Plasma, pericardial fluid and pericardial tissue were obtained in 51 patients receiving open heart surgery (coronary artery bypass grafting, elective heart valvuloplasty or valve replacement). ET concentrations in the plasma, pericardial fluid and pericardial tissues were measured by radioimmunoassay (RIA). ET mRNA expression in the human pericardium was detected by in situ hybridization.(1) The levels of ET in human pericardial fluid was significantly higher than that in the plasma [(128.8 +/- 44.0) ng/L vs. (93.7 +/- 28.6) ng/L, P < 0.001]; (2) ET concentration in the pericardial tissue was (510.3 +/- 156.7) ng/kg; (3) In situ hybridization technique evidenced the abundant ET mRNA expression in human pericardial mesothelial cells.The study indicated that pericardium secreted ET into the pericardial space.
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A metastatic tumor associated with pericardial effusion was diagnosed in a 6-year-old, female, mixed-breed dog. Echocardiography identified multiple echogenic masses adherent to both visceral and parietal pericardium, while results of pericardial fluid cytology were non-diagnostic. The distribution pattern of the masses is remarkable in that they protruded from both pericardial surfaces, rather than one, and demonstrated an oscillatory motion during the cardiac cycle. Pathological examination confirmed the diagnosis of multiple metastatic tumors of the pericardium, with the primary tumor being an anaplastic gastric adenocarcinoma.
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There is evidence that adrenomedullin has autocrine or paracrine activities that oppose cardiac remodelling. However, it remains unclear whether it exerts those local functions in heart failure patients.To investigate the relation between plasma and pericardial fluid concentrations of adrenomedullin and left ventricular haemodynamic variables.Samples of plasma and pericardial fluid were obtained from 50 patients undergoing cardiac surgery. They were classified into two groups: group N (n = 27) with a left ventricular end diastolic volume index (LVEDVI) < or = 90 ml/m(2); and group R (n = 23) with LVEDVI > 90 ml/m(2). Plasma and pericardial fluid concentrations of total adrenomedullin (tAM) and mature adrenomedullin (mAM) were measured and related to the preoperative haemodynamic variables.Pericardial fluid concentrations of mAM were much higher than the plasma concentration in both group N and group R (mean (SEM), 10.6 (1.7) v 3.3 (0.2) fmol/ml, p = 0.0001; and 21.2 (2.8) v 3.9 (0.3) fmol/ml, p < 0.0001, respectively). The ratio mAM/tAM in pericardial fluid was significantly higher than in plasma (0.56 (0.02) v 0.28 (0.02), p < 0.0001). Pericardial fluid concentrations of mAM, but not plasma concentrations, were significantly correlated with LVEDVI, left ventricular end systolic volume index, left ventricular ejection fraction, and left ventricular mass index (r = 0.60, 0.63, -0.54, and 0.47, respectively).Raised pericardial fluid concentrations of mAM may reflect the actions of adrenomedullin as a local mediator against cardiac remodelling in patients with left ventricular dysfunction.
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Pericardial effusion is the accrued of extra fluid inside the quantity around the heart. When there's a fluid build-up in the space between the pericardium, it is able to purpose a country called pericardial effusion. If the fluid set up swiftly, it could cause cardiac stopper. This is a surprising construct-up of fluid in between the layers of the pericardium that keeps coronary heart from functioning like it have to and might reason blood pressure to deposit.
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This report deals with a dog which was presented for ascites that appeard to be related to fluid accumulation in the pericardium. Subsequent to resection of the pericardium the ascites disappeared but a few months later there was fluid accumulation in the thorax. Cytological examination of the thoracic fluid revealed the cell aggregates ("cell balls") which are indicative of mesothelioma and this diagnosis was confirmed by the autopsy findings. The initial cytological diagnosis on the pericardial fluid, which was not in agreement with the histology of the excised pericardium, is also discussed.
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