ABSTRACT
Background: Myocardial revascularization surgery has used several vessels as coronary grafts including internal mammary and radial arteries which have a better prognosis than saphenous vein. Their long-term patency has been associated with the reléase of endothelium vasodilator and anti-aggregating producís such as prostacyclin. Diabetes induces endothelial dysfunction and a high number of diabetics require revascularization. Aim: To assess the capacity to synthesize prostacyclin of different vessels from diabetics. Material and methods: Internal mammary and radial arteries and saphenous veins obtained from 10 diabetic and 10 non diabetic patients subjected to coronary artery bypass surgery were studied. The capacity to synthesize prostacyclin was assessed in these vessels measuríng its hydrolysis product, the 6-keto-PGFla by radioimmunoassay. Results: Internal mammary arteries and saphenous veins from diabetics synthesized a lower amount of prostacyclin than those from non-diabetics. The radial artery produced similar amounts of prostacyclin in both groups. This response was associated with an increase of the conversión of the precursor arachidonic acid to prostacyclin. The saturating concentrations of this acid required to achieve the maximal stimulation were higher in the radial artery (20 µM) than in the internal mammary artery and saphenous vein (10 µM), suggesting that the enzymatic activity of the radial artery was not affected by diabetes. Conclusions: The radial artery appears as the best replacement vessel for coronary surgery in diabetics. Its favorable biochemical profile and potential lower long-term occlusion rate may be relevant for a better prognosis of myocardial revascularization in these patients.
Subject(s)
Humans , Middle Aged , Coronary Artery Bypass , Diabetes Complications , Epoprostenol/biosynthesis , Mammary Arteries/metabolism , Radial Artery/metabolism , Saphenous Vein/metabolism , Arachidonic Acid/pharmacology , Coronary Disease/surgery , Endothelium, Vascular/metabolism , Graft Occlusion, Vascular/physiopathology , Mammary Arteries/transplantation , Nitric Oxide/metabolism , Prognosis , Radial Artery/transplantation , Vasoconstriction/physiology , Vasodilation/physiologyABSTRACT
BACKGROUND: The endothelial cells produce the most potent vasoconstrictor known as endothelin-1. Elevated plasma levels of endothelin have been associated with coronary artery disease, essential hypertension and heart failure. The aims of the present study were, to compare the plasma endothelin-1 levels in coronary artery disease patients and healthy controls, to confirm endothelin-1 as surrogate marker for coronary artery disease and to compare the presence of endothelin-1 like immunoreactivity in aortic and internal mammary artery specimens obtained during coronary artery bypass graft surgery. METHODS AND RESULTS: The circulating levels of endothelin-1 were determined by enzyme-linked immunoassay in patients of coronary artery disease (n=145) and compared with healthy controls (n=70). Tissue endothelin-1 immunoreactivity was examined by immunohistochemical method in aortic and internal mammary artery tissue specimens obtained from 20 patients of coronary artery disease during coronary artery bypass grafting to understand the role of endothelin in atherosclerosis. Significantly higher levels (p < 0.001) of endothelin-1 were observed in all patients of coronary artery disease as compared to healthy controls. The immunoreactivity of endothelin-1 was localized to endothelial cell layer in internal mammary artery whereas in aortic specimens, in addition to endothelial cell layer, immunoreactivity was seen in the cytoplasm of smooth muscle cells of intima and media. CONCLUSIONS: The significant increase in plasma endothelin-1 in coronary artery disease cases as compared to healthy subjects and presence of tissue endothelin-1 immunoreactivity in smooth muscle cells of intimal as well as medial layers of aorta confirms the role of endothelin-1 as a surrogate marker of atherosclerosis.