Abstract
Objectives: Myocardial ischemia offers paradoxical protection from ischemic necrosis by the development of coronary collateral circulation through the process of angiogenesis. The current study aimed to assess the plasma levels of vascular endothelial growth factor basic fibroblast growth factor nitric oxide and copper as angiogenic biomarkers to evaluate their role in the development of coronary collateral circulation in patients with chronic ischemic heart disease. Also, to evaluate the angiogenic modulator effects of coronary artery bypass grafting (CABG) via repeated measurements of such biomarkers 3 months postoperative. Methods: This case control and observational study involved 25 ischemic heart disease male patients candidate for elective coronary artery bypass grafting who admitted at the department of cardiothoracic surgery, faculty of medicine, Assiut University and 25 healthy age matched males as control group. Spectrophotometric assay of NO and copper and ELISA assay of VEGF and bFGF plasma levels were done. Results: Significant higher plasma VEGF, bFGF, copper and NO levels preoperatively when compared with the control group (p<0.01 for all) with significant lowering of their plasma levels when repeatedly measured three months following the CABG (p<0.01 for all). Conclusions: Our findings revealed that plasma levels of VEGF, bFGF, copper and NO have been significantly decreased in patients with chronic myocardial ischemia following CABG, thus, proving the proper coronary reperfusion effect of CABG with decrease the demand for the angiogenesis in the ischemic myocardium. There was a positive correlation between the plasma levels of VEGF and NO.
Highlights
Coronary artery bypass grafting (CABG) is characterized as "open-heart surgery" in which a part of a blood vessel is grafted from the aorta to the coronary artery to bypass the occluded part of the coronary artery and enhance the blood supply to the heart, so the basic premise of CABG is to restore perfusion to the myocardium [1].Angiogenesis, called neovascularization, happens in the healthy body for mending wounds and for restoring blood supply to the damaged tissue
In addition to routine blood analysis preoperatively in the form of complete blood count, liver and kidney function tests, coagulation profile, fasting blood sugar, serum electrolytes in the form of sodium, potassium, calcium and magnesium, three mls venous blood was drawn from all patients and control group, on EDTA tubes, for assay vascular endothelial growth factor (VEGF), basic fibroblast growth factor (bFGF), copper and nitric oxide, they were centrifuged at 3500 rpm for 15 min at 4°C and the plasma were transferred into 1 ml cryotubes, and stored at -80°C for later analyses
Our findings were in disagreement with Ramos et al [27] who found significant lower plasma levels of VEGF among coronary artery disease patients versus the control group and concluded that plasma VEGF levels in those patients progressively increase after revascularization by percutaneous coronary intervention (PCI) during one-year reaching the levels observed in controls
Summary
Coronary artery bypass grafting (CABG) is characterized as "open-heart surgery" in which a part of a blood vessel is grafted from the aorta to the coronary artery to bypass the occluded part of the coronary artery and enhance the blood supply to the heart, so the basic premise of CABG is to restore perfusion to the myocardium [1].Angiogenesis, called neovascularization, happens in the healthy body for mending wounds and for restoring blood supply to the damaged tissue. Coronary artery bypass grafting (CABG) is characterized as "open-heart surgery" in which a part of a blood vessel is grafted from the aorta to the coronary artery to bypass the occluded part of the coronary artery and enhance the blood supply to the heart, so the basic premise of CABG is to restore perfusion to the myocardium [1]. Angiogenesis assumes a part in the reaction to ischemia by the heart muscle. Myocardial ischemia provides paradoxical protection from ischemic necrosis by formation of coronary collateral circulation [3], which helps the newly formed vessels to supply the ischemic tissue [2]. A biochemical effect produced by the ischemic myocardium has been found to initiate the events leading to DNA formation and to mitosis in the collateral vessels [4]. The best known growth factors with demonstrated angiogenic power are vascular endothelial growth factor (VEGF) and basic fibroblast growth factor (bFGF) [5]
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