Acute effects of cigarette smoking on the cardiac diastolic functions

Smoking is an independent risk factor for coronary heart diseases and it increases all causes of cardiovascular morbidity and mortality.

To assess the acute effect of cigarette smoking on ventricular diastolic functions (LV and RV) in healthy, young, and slim smokers.

Thirty volunteers who had recently commenced smoking (less than one year) and who smoked 1-2 cigarettes per day, underwent ECG, 2D and M-mode echocardiography, standard Doppler echocardiography, pulsed TDI (tissue Doppler imaging) on septal and lateral side of mitral annulus and lateral tricuspid annulus. Vp values were measured. The investigator asked them to hold smoking for at least two days after which echocardiographic examination was conducted before smoking one cigarette and the second examination conducted immediately after smoking one cigarette containing at least 0.4 mg of nicotine.

Doppler findings over the mitral valve showed the E wave was significantly reduced from 82.7 ± 10.4 to 74.6 ± 10.4 after smoking; the A wave increased; the E/A ratio was reduced from 1.5 ± 0.3 to 1.2 ± 0.2; the E' septal significantly decreased (15.3 ± 2.4 vs. 11.2 ± 1.1) after smoking, and the E/E' ratio increased from 5.5 ± 1.1 to 6.7 ± 1.1. Doppler findings over the tricuspid valve showed the E wave was reduced from 60.6 ± 9.7 to 52.7 ± 9.6; the A wave increased from 42.2 ± 6.5 to 50.1 ± 6.6; and the E/A ratio decreased (1.45 ± 0.25 vs. 1.06 ± 0.19). The E' significantly decreased from 14.1 ± 1.8 to 10.9 ± 2.4, while the A' increased (10.2 ± 2.4 vs. 12.7 ± 3.6) after smoking; and the IVRT of the RV was significantly prolonged from 62.9 ± 7.5 to 68.7 ± 7.9 after smoking. The Vp was markedly reduced from 67.8 ± 8 to 55.2 ± 3.5 after smoking. These findings reflected on the LV filling pressure (LVFvp) which increased from 9.8 ± 1.4 to 10.5 ± 1.3 after smoking. All changes were statistically significant at P < 0.001.

Our study reveals that cigarette smoking can result in significant acute alteration in the diastolic functions of both ventricles.