Predictive value of palmitoylcarnitine in serum of cardiosurgical patients for impaired tissue oxygenation

Palmitoylcarnitine is suggested to be involved in the pathological process of cardiac ischemia. Recent experimental data revealed correlation between fatty acid transporter levels and palmitate oxidation rate with ejection fraction in the infarcted heart . Moreover, chronic hypoxia in case of ischemic heart disease alters fatty acid composition in the myocardium.Palmitate not only reduces blood pressure and heart rate but is only suggested to decrease the enzymatic activities of the mitochondrial respiratory chain. In a pilot study we addressed the perioperative alterations of the plasma fatty acid composition by elevation of acylcarnitines (AC) with special consideration of the palmitoylcarnitine (C16-AC) serum levels.We studied eleven patients choosen consecutively (7 male, 4 female) for elective cardiosurgical procedure. Directly before and after heart arrest, heparinisied blood specimen were taken. The specimen were dried on filter paper strips for further acylcarnitine- analysis by ESI-MS/MS. Results were adjusted to carnitine final concentrations in mmol/l and correlated to clinical data.Independent from gender, age, medication of lipostatins, known CIHD or pulmonary diseases,7 patients found to have a postoperative decrease of C16-AC. Data of C14-AC and C18-AC had no change. These patients had clear lower preoperative ejection fraction. Highest level of C16-AC was found when patients suffered from myocardial infarction within 6 months pre op.These first data indicate further clinical investigations about mitochondrial oxidative capacity as reflection of mitochondrial functional deterioration by palmitoyl carnitine (Ca++ release or ROS production)