J Clin Med Res

Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Clin Med Res and Elmer Press Inc

Journal website http://www.jocmr.org

Original Article

Volume 3, Number 5, October 2011, pages 230-238

Effect of Serotonin Reuptake Inhibitors on Pulmonary Hemodynamics in Humans

**Table 1.** Patient Characteristics, Medical Data, and Data on Surgical Procedures
	SRI group	Control group	P value
Age, weight, ejection fraction, LVEDP, surgical time, CPB time, XC time, preoperative blood hemoglobin concentration, and preoperative serum creatinine concentration are given as mean (SD), Student’s t-test. Number of bypasses is given as median (range), Wilcoxon-Mann-Whitney U test. Gender, NYHA class, ASA class, number of patients with previous myocardial infarction, heart failure, hypertension, and diabetes, and number of patients with a history of smoking within the last two months prior to surgery are given as numbers in each group, Fisher’s exact test. ASA class: American Society of Anesthesiologists preoperative risk classification; CPB: cardiopulmonary bypass; LVEDP: left ventricular end diastolic pressure; NYHA: New York Heart Association; SRI: serotonin reuptake inhibitor; XC: aortic cross clamp.Data on LVEDP were missing for 3 patients in the SSRI group and 4 patients in the control group. For ejection fraction and preoperative blood hemoglobin concentration, data were missing from one patient in the control group.
Age (years)	60.5 (5.1)	61.0 (3.8)	0.83
Body weight (kg)	90.6 (13.4)	84.9 (7.3)	0.31
Gender (males/females)	5/3	5/3	1.00
Previous myocardial infarction (n)	4	3	1.00
Heart failure (n)	1	1	1.00
Systemic hypertension (n)	4	1	0.20
Diabetes (n)	2	3	1.00
Current smoker (n)	1	1	1.00
Ejection fraction (%)	64.1 (9.9)	63.3 (13.4)	0.89
LVEDP (mmHg)	13 (4.0)	20 (6.1)	0.10
Preoperative blood hemoglobin concentration (g/dL)	13.9 (1.1)	14.0 (1.0)	0.90
Preoperative serum creatinine concentration (µmol/L)	82.5 (12.5)	72.4 (8.4)	0.08
NYHA class I/II/III/IV (n)	0/0/8/0	0/1/7/0	1.00
ASA class 3/4 (n)	6/2	8/0	0.47
Surgical time (min)	137 (27)	140 (19)	0.19
CPB time (min)	58 (13)	59 (16)	0.42
XC time (min)	38 (10)	37 (13)	0.48
Number of distal anastomoses	3 (1-4)	4 (2-5)	0.09

Table 1. Patient Characteristics, Medical Data, and Data on Surgical Procedures

SRI group

Control group

P value

Age, weight, ejection fraction, LVEDP, surgical time, CPB time, XC time, preoperative blood hemoglobin concentration, and preoperative serum creatinine concentration are given as mean (SD), Student’s t-test. Number of bypasses is given as median (range), Wilcoxon-Mann-Whitney U test. Gender, NYHA class, ASA class, number of patients with previous myocardial infarction, heart failure, hypertension, and diabetes, and number of patients with a history of smoking within the last two months prior to surgery are given as numbers in each group, Fisher’s exact test. ASA class: American Society of Anesthesiologists preoperative risk classification; CPB: cardiopulmonary bypass; LVEDP: left ventricular end diastolic pressure; NYHA: New York Heart Association; SRI: serotonin reuptake inhibitor; XC: aortic cross clamp.Data on LVEDP were missing for 3 patients in the SSRI group and 4 patients in the control group. For ejection fraction and preoperative blood hemoglobin concentration, data were missing from one patient in the control group.

Age (years)

60.5 (5.1)

61.0 (3.8)

0.83

Body weight (kg)

90.6 (13.4)

84.9 (7.3)

0.31

Gender (males/females)

5/3

1.00

Previous myocardial infarction (n)

1.00

Heart failure (n)

1.00

Systemic hypertension (n)

0.20

Diabetes (n)

1.00

Current smoker (n)

1.00

Ejection fraction (%)

64.1 (9.9)

63.3 (13.4)

0.89

LVEDP (mmHg)

13 (4.0)

20 (6.1)

0.10

Preoperative blood hemoglobin concentration (g/dL)

13.9 (1.1)

14.0 (1.0)

0.90

Preoperative serum creatinine concentration (µmol/L)

82.5 (12.5)

72.4 (8.4)

0.08

NYHA class I/II/III/IV (n)

0/0/8/0

0/1/7/0

1.00

ASA class 3/4 (n)

6/2

8/0

0.47

Surgical time (min)

137 (27)

140 (19)

0.19

CPB time (min)

58 (13)

59 (16)

0.42

XC time (min)

38 (10)

37 (13)

0.48

Number of distal anastomoses

3 (1-4)

4 (2-5)

0.09

**Table 2.** Hemodynamic Measurements and Calculations, and B_max and K_d for [³H]LSD Binding to Platelet 5-HT_2A Receptors
	SRI group	Control group	P value
All variables are given as mean (SD), Student’s t-test. SRI: serotonin reuptake inhibitor; HR: heart rate; MAP: mean arterial pressure; CVP: central venous pressure; SPAP: systolic pulmonary artery pressure; MPAP: mean pulmonary artery pressure; DPAP: diastolic pulmonary artery pressure; PCWP: pulmonary capillary wedge pressure; CO: cardiac output; SVR: systemic vascular resistance; PVR: pulmonary vascular resistance.
SPAP (mmHg)	23.9 (4.3)	24.6 (5.2)	0.76
MPAP (mmHg)	15.0 (2.5)	14.5 (3.7)	0.50
DPAP (mmHg)	10.5 (3.5)	8.9 (3.0)	0.34
PCWP (mmHg)	8.5 (2.8)	8.3 (3.4)	0.88
MAP (mmHg)	90 (10)	100 (14)	0.13
CVP (mmHg)	3.6 (1.7)	4.0 (3.6)	0.79
HR (beats/min)	62 (8)	55 (10)	0.13
CO (L/min)	5.0 (1.0)	5.2 (0.8)	0.70
SVR (dyne·sec/cm5)	1412 (302)	1511 (383)	0.58
PVR (dyne·sec/cm5)	104 (40)	89 (29)	0.42
B_max (fmol/mg protein)	37.6 (13.0)	37.0 (7.4)	0.91
K_d (nM)	0.55 (0.32)	0.68 (0.25)	0.37

Table 2. Hemodynamic Measurements and Calculations, and B_max and K_d for [³H]LSD Binding to Platelet 5-HT_2A Receptors

SRI group

Control group

P value

All variables are given as mean (SD), Student’s t-test. SRI: serotonin reuptake inhibitor; HR: heart rate; MAP: mean arterial pressure; CVP: central venous pressure; SPAP: systolic pulmonary artery pressure; MPAP: mean pulmonary artery pressure; DPAP: diastolic pulmonary artery pressure; PCWP: pulmonary capillary wedge pressure; CO: cardiac output; SVR: systemic vascular resistance; PVR: pulmonary vascular resistance.

SPAP (mmHg)

23.9 (4.3)

24.6 (5.2)

0.76

MPAP (mmHg)

15.0 (2.5)

14.5 (3.7)

0.50

DPAP (mmHg)

10.5 (3.5)

8.9 (3.0)

0.34

PCWP (mmHg)

8.5 (2.8)

8.3 (3.4)

0.88

MAP (mmHg)

90 (10)

100 (14)

0.13

CVP (mmHg)

3.6 (1.7)

4.0 (3.6)

0.79

HR (beats/min)

62 (8)

55 (10)

0.13

CO (L/min)

5.0 (1.0)

5.2 (0.8)

0.70

SVR (dyne·sec/cm5)

1412 (302)

1511 (383)

0.58

PVR (dyne·sec/cm5)

104 (40)

89 (29)

0.42

B_max (fmol/mg protein)

37.6 (13.0)

37.0 (7.4)

0.91

K_d (nM)

0.55 (0.32)

0.68 (0.25)

0.37

**Table 3.** Individual Data for the Patients Included, Including Types and Doses of the Serotonin Reuptake Inhibitors, Mean Pulmonary Arterial Pressures, Platelet 5-HT_2A Receptor Binding Data, and Serotonin Transporter and 5-HT_2A Receptor Genotypes
Patient number	Age, gender	Type and dose of SRI (mg/d)	Treatment duration with SRI (months)	SRI serum concen-tration (nmol/L)	MPAP (mmHg)	Bmax, 5-HT_2A receptor binding (fmol/mg protein)	Kd, 5-HT2A receptor binding (nM)	SERT S/L genotype	5-HTR2A 102 T > C genotype
F: female; M: male; ESC: escitalopram; CIT: citalopram; VEN: venlafaxine; MPAP: mean pulmonary arterial pressure; SERT: serotonin transporter gene; S/L: short/long; 5HTR2A: serotonin 2A receptor gene. ¹Approximate value.²Sum of the concentration of venlafaxine and the active metabolite O-desmethylvenlafaxine.
SRI group
1	60, M	ESC, 20	13	107	12	45.8	0.68	LL	CC
2	57, F	ESC, 10	20	68	12	44.6	1.24	LS	CC
3	61, M	CIT, 10	2	56	17	36.1	0.67	SS	TC
4	55, M	CIT, 20	24¹	171	16	46.8	0.43	LL	CC
5	64, M	CIT, 40	120¹	170	16	58.1	0.46	LL	CC
6	57, M	CIT, 40	6	391	15	21.7	0.33	LS	TC
7	59, F	CIT, 20	84¹	124	19	25.8	0.37	LL	TT
8	71, F	VEN, 75	60¹	340²	13	32.2	0.23	LS	TT
Control group
9	61, M	-	-	-	10	27.5	0.92	LS	TT
10	66, M	-	-	-	12	43.4	0.58	LS	TC
11	61, F	-	-	-	20	43.4	0.49	SS	TT
12	58, M	-	-	-	13	40.9	0.40	SS	TC
13	56, M	-	-	-	19	41.4	0.58	LS	TC
14	60, M	-	-	-	14	40.4	0.76	SS	TT
15	59, F	-	-	-	11	34.8	1.17	LS	TC
16	67, F	-	-	-	17	24.2	0.57	LL	TC

Table 3. Individual Data for the Patients Included, Including Types and Doses of the Serotonin Reuptake Inhibitors, Mean Pulmonary Arterial Pressures, Platelet 5-HT_2A Receptor Binding Data, and Serotonin Transporter and 5-HT_2A Receptor Genotypes

Patient number

Age, gender

Type and dose of SRI (mg/d)

Treatment duration with SRI (months)

SRI serum concen-tration (nmol/L)

MPAP (mmHg)

Bmax, 5-HT_2A receptor binding (fmol/mg protein)

Kd, 5-HT2A receptor binding (nM)

SERT S/L genotype

5-HTR2A 102 T > C genotype

F: female; M: male; ESC: escitalopram; CIT: citalopram; VEN: venlafaxine; MPAP: mean pulmonary arterial pressure; SERT: serotonin transporter gene; S/L: short/long; 5HTR2A: serotonin 2A receptor gene. ¹Approximate value.²Sum of the concentration of venlafaxine and the active metabolite O-desmethylvenlafaxine.

SRI group

60, M

ESC, 20

107

45.8

0.68

57, F

ESC, 10

44.6

1.24

61, M

CIT, 10

36.1

0.67

55, M

CIT, 20

24¹

171

46.8

0.43

64, M

CIT, 40

120¹

170

58.1

0.46

57, M

CIT, 40

391

21.7

0.33

59, F

CIT, 20

84¹

124

25.8

0.37

71, F

VEN, 75

60¹

340²

32.2

0.23

Control group

61, M

27.5

0.92

66, M

43.4

0.58

61, F

43.4

0.49

58, M

40.9

0.40

56, M

41.4

0.58

60, M

40.4

0.76

59, F

34.8

1.17

67, F

24.2

0.57