Endothelial dysfunction and smoking factor in patients with coronary heart disease while testing the radial artery prior to coronary bypass surgery

Abstract

Patients (111 males) with coronary heart disease (CHD) and angina, II-III functional class, accompanied by arterial hypertension (AH), I-III degree, in 77 % of cases (mean age was 62.00.76 years) were examined prior to coronary bypass surgery. The patients were divided into two groups: group 1 consisted of 56 nonsmoking patients (112 upper extremities) and group 2 - 55 smoking patients (110 upper extremities) with the experience of smoking being 331.6 years on average. The thumb of both the right and left hand was tested for peripheral microcirculatory blood flow (MBF) by using a laser-Doppler flowmetry method (LDF). This quantitative method was developed at our clinic to assess the adequacy of collateral circulation in the hand. The method compares MBF provided by the ulnar artery, with the radial artery occluded, with the background level. Some features of various clinical parameters in the group of smokers suffering from coronary artery disease were analyzed in comparison with those of non-smokers. Significant differences were found in the indicators of lipid profile: increased levels of total cholesterol and low-density lipoprotein (LDL) against the background of low high-density lipoprotein (HDL) in the group of smoking patients. We found out that the smokers had to apply for surgical treatment by 7 years (on average) earlier; they had a significantly greater number of heart attacks and showed the lowest body mass index (BMI). The LDF test helped to establish that smoking in patients with CHD enhances the endothelial dysfunction, while significantly reducing the reactivity of the microvascular bed under the influence of hyperemic stimulus. Sampling the radial artery for coronary artery bypass grafting in smokers tended to give negative results.