title: Comparison of pulmonary and systemic effects of adenosine triphosphate in chronic obstructive pulmonary disease--ATP: a pulmonary controlled vasoregulator?
abstract: During stepwise incremental intravenous adenosine triphosphate (ATP) infusion, systemic and pulmonary vascular effects were compared in 10 patients with stable chronic obstructive pulmonary disease (COPD). Pulmonary vasodilation was: 1) predominant and maximal as early as the lowest dose infusion (0.1 mumol.kg-1.min-1) with pulmonary arterial mean pressure (Ppa) (-16%; p less than 0.01) and pulmonary vascular resistance (PVR) decreases (-28%; p less than 0.005) and simultaneous increasing delta PVR/delta SVR ratio; 2) associated with worsening hypoxaemia (-14%; p less than 0.001), but also with increasing alveolar-arterial oxygen pressure difference (P(A-a)O2) and venous admixture (Qs/Qt) suggesting some inhibition of hypoxic pulmonary vasoconstriction. Systemic vasodilation was: 1) clearly dose-dependent, but only reached significant level at 0.2 mumol.kg-1.min-1 with systemic arterial mean pressure (Psa) (-12.5%; p less than 0.05) and systemic vascular resistance (SVR) decreases (-30%; p less than 0.01); 2) associated with arterial carbon dioxide tension (PaCO2) decrease (-12.5%; p less than 0.005) and recurring uncontrollable hyperpnoea, suggesting a ventilatory stimulatory effect of ATP in man. In patients with stable COPD, ATP infusion has dual acute haemodynamic effects depending on the dose-level. The predominant pulmonary vasodilating effect occurs as early as the lowest dose-levels without any further increase of pulmonary vasodilation. This contrasts with the dose-related systemic vasodilation effect. Such a dual haemodynamic effect is an indirect indication of in vivo lung metabolism of ATP.
authors.affiliation: Service d'Exploration de la Fonction Respiratoire, Hôpital Aiguelongue, Montpellier, France.
authors.forename: S J
authors.initials: SJ
authors.lastname: Gaba
authors.forename: C
authors.initials: C
authors.lastname: Préfaut
mesh_terms: D000255:Adenosine Triphosphate / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology*; D000368:Aged; D004305:Dose-Response Relationship, Drug; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D007262:Infusions, Intravenous; D008168:Lung / Q000098:blood supply* / Q000187:drug effects; D008173:Lung Diseases, Obstructive / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D014664:Vasodilation / Q000187:drug effects*
chemical_list: D000255:Adenosine Triphosphate