Elevated coronary endothelin-1 but not nitric oxide in diabetics during CABG.
BACKGROUND
After coronary artery bypass grafting procedures, a higher incidence of morbidity and mortality has been reported in diabetic patients. We tested whether coronary artery bypass grafting in diabetics affects the endothelin-1 and nitric oxide coronary effluent profile during reperfusion.


METHODS
Twenty-one consecutive patients (9 with type II diabetes mellitus, 12 non-diabetics) underwent coronary artery bypass grafting by one surgeon. The two groups did not differ in preoperative ejection fraction, Parsonnet score, number of vessels bypassed, or cross-clamp time. Each patient was treated in the same intraoperative manner with single atrial, aortic, and antegrade and retrograde cardioplegia (CPL) cannulas. Cold CPL arrest was by antegrade and retrograde infusion of modified Buckberg CPL solution. Warm CPL solution was infused before reperfusion. Coronary sinus blood samples were obtained for estimation of endothelin-1 and nitrite plus nitrate before CPL arrest and at 1 and 15 minutes after each of 2 reperfusion periods.


RESULTS
In diabetics, endothelin-1 was significantly increased at all reperfusion times as compared with non-diabetics. Nitrite plus nitrate levels were significantly higher in patients with diabetes than in those without, but did not change with time in either of the groups.


CONCLUSIONS
Reperfusion after CPL during coronary artery bypass grafting procedure can trigger the release of endothelin-1 in patients with diabetes mellitus. This may favor increased vascular tone or positive inotropic responses after coronary artery bypass grafting and may contribute to significant cardiovascular consequences in diabetic patients.
Sharma
A C
AC
Department of Surgery, University of Illinois College of Medicine at Chicago, 60612, USA.
Fogelson
B G
BG
Nawas
S I
SI
Vigneswaran
W T
WT
Sam
A D
AD
Alden
K J
KJ
Ferguson
J L
JL
Law
W R
WR
D001026:Coronary Artery Bypass; D003924:Diabetes Mellitus, Type 2 / Q000097:blood*; D019332:Endothelin-1 / Q000097:blood*; D005260:Female; D006324:Heart Arrest, Induced; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D009566:Nitrates / Q000097:blood; D009569:Nitric Oxide / Q000097:blood*
D019332:Endothelin-1; D009566:Nitrates; D009569:Nitric Oxide