Morphological and Functional Remodeling of the Ischemic Heart Correlates with Homocysteine Levels

Figure 1. Data show that homocysteine levels of the plasma and pericardial fluid (PF) are similar and correlate to each other in patients undergoing CABG surgery (n = 14). Two-tailed independent t-test showed no difference between plasma and PF tHcy levels (p > 0.05) (A). Pearson’s correlation analysis showed a positive correlation between plasma and PF levels of CABG patients (B). y = 1.121x − 3.183, r = 0.9, p < 0.0001. PF—pericardial fluid, tHcy—total homocysteine; Data expressed as mean ± SEM; p < 0.05 was considered significant.

Figure 2. (A) Two-dimensional transthoracic echocardiographic image of a CABG patient with tHcy < 12 μM/L. Left panel: parasternal long axis view: normal thickness of interventricular septum (IVS) and posterior wall (PW) can be seen (10 mm). Right panel: Apical four-chamber view shows a normal left-ventricular end-diastolic diameter (LVED = 40 mm). (B) Two-dimensional transthoracic echocardiographic image of a CABG patient with tHcy > 12 μM/L. Left panel: Parasternal long axis view: considerably increased (14 mm) thickness of interventricular septum (IVS) and posterior wall (PW) can be seen. Right panel: Apical four-chamber view shows an increased left-ventricular end-diastolic diameter (LVED = 60 mm).

Figure 3. Data show that echocardiographic parameters of the heart correlate with homocysteine levels of patients undergoing CABG surgery. Pearson’s correlation analysis showed positive correlations between tHcy levels vs. LVED (y = 0.8499x + 38.76; r = 0.6; p < 0.01), LVDS (y = 0.9713x + 19.82; r = 0.7; p < 0.01), LA (y = 0.2956x + 12.54, r = 0.7, p < 0.01; A–C), and an inverse correlation between tHcy levels vs. LVEF (y = −1.0154x + 69.299; r = 0.5; p < 0.05) (D). CABG—coronary artery bypass graft surgery; LVED—left ventricular end-diastolic diameter; LVDS—left ventricular end-systolic diameter; LA—area of the left atrium; LVEF—left-ventricular ejection fraction; tHcy—total homocysteine; p < 0.05 was considered significant.

Figure 4. Data show that in CABG patients, compared to the plasma level, cTn-I level is significantly greater in the pericardial fluid (PF). Two-tailed independent t-test showed that cTn levels of PF were significantly higher than that of blood plasma (0.01 ± 0.004 vs. 0.07 ± 0.01 ng/mL, respectively, p < 0.05). PF—pericardial fluid, cTn-I—cardiac troponin-I. Data expressed as mean ±SEM. p < 0.05 was considered significant, which is indicated with an asterisk.

Figure 5. Summary of some of the mechanisms involved in the pericardial homocysteine-related cardiac remodeling and coronary dysfunction. SAM: S-adenosylmethionine, SAH: S-adenosylhomocysteine, ADMA: asymmetric dimethylarginine NOS: nitric oxide synthase, PON: peroxynitrite, ET: endothelin.

Figure 6. On the basis of our findings, we developed hypothetical cardiac cycles indicating the differences in the cardiac function of the two groups of patients with lower or higher levels of homocysteine.