title: Persistence of arterial functional abnormalities after successful coronary revascularization.
abstract: BACKGROUND
  In patients with myocardial ischemia and coronary atherosclerosis, arterial stiffness and endothelial function are impaired. Whether these alterations can be favorably affected by successful coronary revascularization is debated.
  
  
  METHODS
  We studied 39 hospitalized patients 59.3 ± 3.2 years old (mean ± SEM). In 21 patients with angiographic evidence of significant coronary artery stenosis, revascularization procedures were performed (stenting n = 11 and bypass surgery n = 10). The remaining patients had no significant stenosis and thus served as controls. Prerevascularization measurements included carotido-femoral pulse wave velocity (PWV), radial artery flow-mediated vasodilatation and a complete echocardiographic examination. The same measurements were performed 6 months later. Pharmacological treatment consisted of different cardiovascular drugs and remained substantially unchanged over the 6-month follow-up period.
  
  
  RESULTS
  With the exception of an increased left ventricular mass index (LVMI; 130 ± 5.3 versus 105.8 ± 7.2 g/m(2), P < 0.05) and a lower Em/Am (0.6 ± 0.01 and 0.8 ± 0.01 respectively, P < 0.05) observed in patients with coronary stenosis, all other hemodynamic, cardiac and vascular variables were similar in the two groups. Following the 6-month follow-up period, all variables remained substantially unchanged, with the exception, in revascularized patients, of a significant reduction in LVMI (-12%, P < 0.05) and an improvement in Tissue Doppler Imaging-measured diastolic function (Em/Am + 30%, P < 0.05). This was not associated, however, with any significant change in PWV and in flow-mediated vasodilatation.
  
  
  CONCLUSIONS
  Cardiac revascularization has no effect on arterial function, assessed either as arterial stiffness or as flow-mediated vasodilatation. On the contrary, the improvement in coronary blood flow triggers local cardiac changes, namely, a reduction in LVMI and an improvement in diastolic function.
authors.affiliation: Clinica Medica, H. San Gerardo, Monza, Italy.
authors.forename: Cristina
authors.initials: C
authors.lastname: Giannattasio
authors.forename: Anna C M
authors.initials: AC
authors.lastname: Capra
authors.forename: Ivan
authors.initials: I
authors.lastname: Calchera
authors.forename: Virgilio
authors.initials: V
authors.lastname: Colombo
authors.forename: Francesca
authors.initials: F
authors.lastname: Cesana
authors.forename: Stefano
authors.initials: S
authors.lastname: Nava
authors.forename: Alessandro
authors.initials: A
authors.lastname: Maloberti
authors.forename: Marta
authors.initials: M
authors.lastname: Alloni
authors.forename: Rita
authors.initials: R
authors.lastname: Facchetti
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Trocino
authors.forename: Guido
authors.initials: G
authors.lastname: Grassi
authors.forename: Giovanni
authors.initials: G
authors.lastname: Paolini
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Mancia
mesh_terms: D016022:Case-Control Studies; D023921:Coronary Stenosis / Q000503:physiopathology*; D003331:Coronary Vessels / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged