Pretreatment of human myocardium with adenosine

Objectives. While the role of adenosine pretreatment in animals has been we ll established, the role in humans has been controversial. We performed thi s prospective, randomized study to find out the usefulness of adenosine pre treatment in humans. Patients and methods: Twenty patients undergoing coron ary artery bypass surgery for severe triple vessel disease and left ventric ular dysfunction (ejection fraction <35%) formed the study population. The adenosine group (n = 10) received adenosine infusion (200 <mu>g/kg) before aortic cross-clamp, The control group (n = 10) received only normal saline injection. Cardiac function indices were assessed post-operatively. Results : In the adenosine group there was a significant increase in cardiac output in the post-operative period from 3.46 +/- 1.06 to 4.46 +/- 0.92 l/min (P << 0.05). The cardiac index increased significantly in the adenosine group from 1.97 +/- 0.43 to 2.54 +/- 0.5 l/min per m(2) (P << 0.05) and even when compared with the control group this increase was significant (adenosine g roup vs, control group, P = 0.03). Systemic vascular resistance fell from 1 898.8 +/- 558.4 to 1134.9 +/- 530.7 dyne/s per cm(-5) (P << 0.05) in the ad enosine group. The pulmonary artery wedge pressure fell significantly in th e adenosine group from 11.1 +/- 5.0 to 7.2 +/- 2.6 mmHg (P << 0.05). Patien ts in the adenosine group maintained a lesser increase in resting heart rat e post-operatively (96.1 +/- 13.4 to 114.1 +/- 18.7 beats/min) (P = 0.7), a s compared to the control group where the increase in the heart rate was si gnificant (77.1 +/-. 8.3 to 109.7 +/- 14.9 beats/min) (P << 0.05). In the a denosine group only one patient (10%) had a raised creatine phosphokinase ( MB) level at 12 h post-operatively as compared to three patients (30%) in t he control group (P < 0.05), Conclusions: Adenosine pretreatment appears to protect against reperfusion injury in human hearts and thus results in imp roved post-operative haemodynamics. (C) 2001 Elsevier Science B.V. All righ ts reserved.