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Decreased coronary microvascular reactivity after cardioplegic arrest in patients with uncontrolled diabetes mellitus

Jun Feng1, Louis M Chu, Nikola Dobrilovic

  • 1Division of Cardiothoracic Surgery, Cardiovascular Research Center, Rhode Island Hospital, Alpert Medical School of Brown University, Providence, RI, USA.

Surgery
|July 26, 2012
PubMed

Insights

Uncontrolled diabetes impairs coronary arteriolar function and worsens recovery after heart surgery. This vascular dysfunction is linked to increased protein kinase C and oxidative stress.

Area of Science:

  • Cardiovascular Science
  • Diabetology
  • Vascular Biology

Background:

  • Coronary artery bypass graft surgery involves cardioplegic arrest and reperfusion.
  • Diabetes mellitus, particularly uncontrolled diabetes, can affect vascular health.
  • The impact of diabetes on coronary arteriolar function post-surgery requires further investigation.

Purpose of the Study:

  • To investigate the effects of cardioplegic arrest and reperfusion on coronary arteriolar responses in diabetic and non-diabetic patients.
  • To assess associated signaling pathways, including protein kinase C and oxidative stress.

Main Methods:

  • Coronary arterioles were dissected from atrial tissues of uncontrolled diabetic, well-controlled diabetic, and non-diabetic patients.
  • Vascular responses to vasodilators were measured pre- and post-cardioplegic arrest and reperfusion.
  • Protein expression (PKC-α, PKC-β) and protein oxidation were analyzed.

Main Results:

  • Baseline microvascular responses were reduced in uncontrolled diabetics compared to other groups.
  • Cardioplegic arrest and reperfusion decreased vasodilatory responses in all groups, more so in uncontrolled diabetics.
  • Uncontrolled diabetes showed increased expression of PKC-α, PKC-β, and protein oxidation.

Conclusions:

  • Uncontrolled diabetes causes significant endothelial-dependent and -independent coronary arteriolar dysfunction.
  • Diabetes exacerbates the negative impact of cardioplegic arrest and reperfusion on coronary arterioles.
  • Increased PKC activation and oxidative stress contribute to vascular dysfunction in uncontrolled diabetes.
Abstract

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