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Adenosine plasma level and A2A adenosine receptor expression: correlation with laboratory tests in patients with neurally mediated syncope
  1. Jean-Claude Deharo1,2,
  2. Alexis Mechulan1,
  3. Roch Giorgi3,
  4. Frederic Franceschi1,
  5. Sebastien Prevot1,
  6. Eric Peyrouse1,
  7. Jocelyne Condo2,
  8. Youlet By2,
  9. Jean Ruf2,
  10. Michelino Brignole4,
  11. Régis Guieu2,5
  1. 1APHM, Department of Cardiology, Timone University Hospital, Marseille, France
  2. 2UMR MD2, Université de la Méditerranée, Marseille, France
  3. 3LERTIM, Université de la Méditerranée, Marseille, France
  4. 4Department of Cardiology, Ospedale di Lavagna, Lavagna, Italy
  5. 5Laboratory of Biochemistry and Molecular Biology, Timone University Hospital, Marseille, France
  1. Correspondence to Professor Jean-Claude Deharo, Department of Cardiology, CHU La Timone, 264, Rue Saint Pierre, 13005 Marseille, France; jean-claude.deharo{at}


Objectives The purpose of this study was to investigate the hypothesis that responses to the ATP test and head-up tilt test (HUT) may be correlated with different purinergic profiles.

Design and setting The ATP and HUT identify distinct subsets of patients with neurally mediated syncope (NMS). Adenosine and its A2A receptors (A2AR) may be implicated in the pathophysiology of NMS in patients with positive HUT. Nothing is known about the purinergic profile of patients with positive ATP.

Patients and measures This prospective study includes a consecutive series of patients with suspected NMS. All patients underwent both HUT and ATP. Before testing, samples were collected for measurement of baseline adenosine plasma level (APL) and expression.

Results A total of 46 patients (25 men and 21 women) with a mean age of 57±18 years were enrolled. The HUT test was positive in 27 patients and the ATP test in 20. Both tests were positive in 9 and negative in 8. High APL was associated with high probability of positive HUT while low APL was associated with high probability of positive ATP. Expression of A2AR was lower in patients with positive ATP than in those with positive HUT.

Conclusion These findings indicate that patients with NMS present different purinergic profiles and that responses to HUT and ATP are correlated with these profiles.

  • Neurally mediated syncope
  • adenosine
  • A2A receptors
  • ATP
  • HUT
  • pacemakers
  • implantable cardioverter defibrillator (ICD)
  • endocarditis
  • arrhythmias
  • stroke
  • arrhythmias
  • atrioventricular block
  • syncope

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  • Funding Assistance publqiue des Hopitaux de Marseille (AORC) and Federation Française de Cardiology. Grant Number 10.000 euros.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval Ethics approval was obtained from the Ethics Committee for Human Research of Timone University Hospital.

  • Provenance and peer review Not commissioned; internally peer reviewed.