title: Acute effects of using an electronic nicotine-delivery device (electronic cigarette) on myocardial function: comparison with the effects of regular cigarettes.
abstract: BACKGROUND
  Electronic cigarettes have been developed and marketed in recent years as smoking substitutes. However, no studies have evaluated their effects on the cardiovascular system. The purpose of this study was to examine the immediate effects of electronic cigarette use on left ventricular (LV) function, compared to the well-documented acute adverse effects of smoking.
  
  
  METHODS
  Echocardiographic examinations were performed in 36 healthy heavy smokers (SM, age 36 ± 5 years) before and after smoking 1 cigarette and in 40 electronic cigarette users (ECIG, age 35 ± 5 years) before and after using the device with "medium-strength" nicotine concentration (11 mg/ml) for 7 minutes. Mitral flow diastolic velocities (E, A), their ratio (E/A), deceleration time (DT), isovolumetric relaxation time (IVRT) and corrected-to-heart rate IVRT (IVRTc) were measured. Mitral annulus systolic (Sm), and diastolic (Em, Am) velocities were estimated. Myocardial performance index was calculated from Doppler flow (MPI) and tissue Doppler (MPIt). Longitudinal deformation measurements of global strain (GS), systolic (SRs) and diastolic (SRe, SRa) strain rate were also performed.
  
  
  RESULTS
  Baseline measurements were similar in both groups. In SM, IVRT and IVRTc were prolonged, Em and SRe were decreased, and both MPI and MPIt were elevated after smoking. In ECIG, no differences were observed after device use. Comparing after-use measurements, ECIG had higher Em (P = 0.032) and SRe (P = 0.022), and lower IVRTc (P = 0.011), MPI (P = 0.001) and MPIt (P = 0.019). The observed differences were significant even after adjusting for changes in heart rate and blood pressure.
  
  
  CONCLUSIONS
  Although acute smoking causes a delay in myocardial relaxation, electronic cigarette use has no immediate effects. Electronic cigarettes' role in tobacco harm reduction should be studied intensively in order to determine whether switching to electronic cigarette use may have long-term beneficial effects on smokers' health.
  
  
  BACKGROUND
  Current Controlled Trials ISRCTN16974547.
authors: Department of Cardiology, Onassis Cardiac Surgery Center, Sygrou 356, Kallithea 17674, Greece. kfarsalinos@gmail.com.
authors: Konstantinos E
authors: KE
authors: Farsalinos
authors: Dimitris
authors: D
authors: Tsiapras
authors: Stamatis
authors: S
authors: Kyrzopoulos
authors: Maria
authors: M
authors: Savvopoulou
authors: Vassilis
authors: V
authors: Voudris
mesh_terms: D000280:Administration, Inhalation; D000328:Adult; D001794:Blood Pressure / Q000187:drug effects; D015150:Echocardiography, Doppler; D066300:Electronic Nicotine Delivery Systems / Q000009:adverse effects; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D008297:Male; D008943:Mitral Valve / Q000187:drug effects / Q000503:physiopathology; D009538:Nicotine / Q000008:administration & dosage* / Q000009:adverse effects; D018722:Nicotinic Agonists / Q000008:administration & dosage* / Q000009:adverse effects; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects / Q000503:physiopathology; D016540:Smoking Cessation / Q000379:methods*; D000074606:Smoking Prevention; D013997:Time Factors; D014029:Tobacco Use Disorder / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D016277:Ventricular Function, Left / Q000187:drug effects*
chemical_list: D018722:Nicotinic Agonists; D009538:Nicotine