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J Thorac Cardiovasc Surg 2005;129:584-590
© 2005 The American Association for Thoracic Surgery

Cardiopulmonary Support and Physiology

Dynamic and differential changes in myocardial and plasma endothelin in patients undergoing cardiopulmonary bypass

M. Marlina Multani, MS, John S. Ikonomidis, MD, PhD, Peter Y. Kim, MD, Elizabeth A. Miller, MD, Kim J. Payne, MD, Rupak Mukherjee, PhD, B. Hugh Dorman, MD, PhD, Francis G. Spinale, MD, PhD*

Medical University of South Carolina, Charleston, SC, USA

Received for publication December 11, 2003; revisions received June 21, 2004; accepted for publication July 6, 2004.

* Address for reprints: Francis Spinale, MD, PhD, Cardiothoracic Surgery, Room 625, Strom Thurmond Research Building, 770 MUSC Complex, Medical University of South Carolina, 114 Doughty St, Charleston, SC 29425 (E-mail: wilburnm{at}musc.edu).

OBJECTIVE: The bioactive peptide endothelin modulates left ventricular function by changing afterload, coronary vascular tone, and myocardial contractility. However, whether increased plasma endothelin levels observed in patients during and after coronary revascularization and cardiopulmonary bypass reflect actual myocardial interstitial levels are unknown.

METHODS: A microdialysis probe (outer diameter: 0.77 mm; length: 4 mm) was placed in the left ventricular apical midmyocardium in 20 patients and myocardial interstitial fluid was collected (2.5 µL/min) at baseline and up to 30 minutes after cardiopulmonary bypass. Myocardial interstitial and systemic arterial endothelin were measured by radioimmunoassay.

RESULTS: Baseline myocardial interstitial endothelin was over 6-fold higher than plasma (20.11 ± 2.07 vs 3.19 ± 0.25 fmol/mL, P < .05). Plasma endothelin increased by 23% ± 12% at 60 minutes of cardiopulmonary bypass whereas myocardial interstitial endothelin increased by 105% ± 24%, P < .05), and this change was higher than in the plasma (P < .05). Although no further change in plasma endothelin occurred during cardiopulmonary bypass, myocardial interstitial levels increased further after crossclamp removal (400% ± 75%) and remained significantly higher than plasma at separation from cardiopulmonary bypass.

CONCLUSION: The unique findings of this study were 2-fold: First, significant compartmentalization of endothelin exists within the human myocardium. Second, a significantly higher and temporally disparate change in myocardial interstitial endothelin occurs during and after cardiopulmonary bypass when compared with systemic levels. These dynamic changes in myocardial endothelin likely influence coronary vascular tone and contractility.




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