Copyright © 2006, European Society of Cardiology
Relationship between oxidative stress, lipid peroxidation, and ultrastructural damage in patients with coronary artery disease undergoing cardioplegic arrest/reperfusion
aInstituto de Investigaciones Cardiológicas "Alberto C. Taquini" UBA-Conicet, Buenos Aires, Argentina
bPhysical Chemistry, School of Pharmacy and Biochemistry, University of Buenos Aires, Argentina
cDepartment of Nutrition, University of California, Davis, USA
dDepartment of Cardiology, University of Naples, Italy
eDivision of Cardiology, University of Perugia, Italy
* Corresponding author. Cardiology, Ospedale Silvestrini, S. Andrea delle Fratte, 06156 Perugia, Italy. Tel.: +39 0755271509; fax: +39 0755271244. Email address: giuseppe.ambrosio{at}ospedale.perugia.it
Objective: In animal models, formation of oxidants during postischemic reperfusion may exert deleterious effects ("oxidative stress"). Cardioplegic arrest/reperfusion during cardiac surgery might similarly induce oxidative stress. However, the phenomenon has not been precisely characterized in patients, and therefore the role of antioxidant therapy at cardiac surgery is a matter of debate. Thus, we wanted to ascertain whether the relationship between oxidant formation and development of myocardial injury also translates to the situation of patients subjected to cardioplegic arrest.
Methods: In 24 patients undergoing coronary artery bypass, trans-cardiac blood samples and myocardial biopsies were taken before cardioplegic arrest and again following reperfusion.
Results: Cardiac glutathione release (marker of oxidant production) was negligible at baseline (0.02±0.04 µmol/L), but it increased 15 min into reperfusion (1.10±0.40 µmol/L; p<0.05); concomitantly, myocardial concentration of the antioxidant ubiquinol decreased from 144.5±52.0 to 97.6±82.0 nmol/g (p<0.05). Although these changes document cardiac exposure to oxidants, they were not accompanied by evidence of injury. Neither coronary sinus blood nor cardiac biopsies showed increased lipid peroxide concentrations. Furthermore, electron microscopy showed no major ultrastructural alterations. Finally, full recovery of left ventricular systolic and diastolic function was observed.
Conclusions: Careful investigation reveals that while oxidant production does occur during cardiac surgery in patients with chronic ischemic heart disease, cardiac oxidative stress may not progress through membrane damage and irreversible injury.
KEYWORDS Oxidative stress; Ischemia; Reperfusion; Coronary artery by-pass graft
Presented in part, XX Congress of the European Society of Cardiology, Barcelona, September 2006.
Supported by Consejo Nacional de Investigaciones Cientíy Técnicas and Universidad de Buenos Aires (Argentina), and grants #RBNE01HLAK_005 and #2003064224_008 from Ministry of University and Research, Italy.
Time for primary review 19 days
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