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CLINICAL RESEARCH: CARDIAC SURGERY

Diabetes Mellitus as a Predictor for Radial Artery Vasoreactivity in Patients Undergoing Coronary Artery Bypass Grafting

Bikram P. Choudhary, MRCS^_*, Charalambos Antoniades, MD, PhD, Alison F. Brading, PhD, Antony Galione, PhD, Keith Channon, MD, FRCP and David P. Taggart, MD, PhD, FRCS^_*,_*

^_* Department of Cardiothoracic Surgery, John Radcliffe Hospital, Oxford, United Kingdom
Department of Cardiovascular Medicine, University of Oxford, Oxford, United Kingdom
Department of Pharmacology, University of Oxford, Oxford, United Kingdom.

Manuscript received February 28, 2007; revised manuscript received May 2, 2007, accepted June 3, 2007.

^_* Reprint requests and correspondence: Dr. David P. Taggart, Department of Cardiothoracic Surgery, John Radcliffe Hospital, Oxford OX3 9DU, United Kingdom. (Email: david.taggart{at}orh.nhs.uk).

Objectives: Our purpose was to examine the impact of diabetes mellitus (DM) on vasoreactivity and endothelial function of radial artery (RA) grafts ex vivo.

Background: The arteriopathy associated with DM may influence the surgeon’s choice of conduits for revascularization. Arterial conduits and especially the RA are prone to vasospasm in the perioperative period.

Methods: The study population consisted of 98 patients with coronary artery disease undergoing coronary artery bypass grafting by using RA grafts. The maximum contractions of RA segments induced by K+ (66 mmol/l) and clinically important vasoconstrictors such as adrenaline (5 x 10^–5 mol/l), angiotensin II (10^–6 mol/l), and prostaglandin F2 (PGF2) (10^–6 mol/l) were recorded. Relaxation of RA rings to carbachol (10^–4 mol/l) was used as a measure of endothelial function. Multivariate analysis was then applied to determine the role of clinical characteristics on the vasomotor responses to these agents.

Results: Vessels from patients with DM had greater contractions in response to adrenaline (p < 0.05), angiotensin (p < 0.05), and PGF2 (p < 0.01) compared with non-DM vessels, despite the similar vasoconstrictions induced by high K+ (p = NS). Diabetes mellitus was also associated with smaller vasorelaxations in response to carbachol (p < 0.001). In multivariate analysis, DM was an independent predictor of RA contractions in response to adrenaline (ß [SE] 3.085 [1.410], p = 0.031), angiotensin II (ß [SE] 3.838 [1.552], p = 0.015), and PGF2 (ß [SE] 4.609 [1.908], p = 0.018) but not K+ (p = NS). Diabetes mellitus was also independently associated with the vasorelaxations in response to carbachol (ß [SE] –15.645 [2.622], p = 0.0001).

Conclusions: Diabetes mellitus is associated with impaired endothelial function and greater contractions of RA grafts in response to all of the clinically relevant vasoconstrictors. These findings suggest that the RA of diabetic patients may be more prone to spasm in response to endogenous vasoconstrictors, an observation with important implications for surgeons’ choice of conduits in this cohort of patients.

Abbreviations and Acronyms   CABG = coronary artery bypass grafting   CAD = coronary artery disease   DM = diabetes mellitus   HbA1c = glycosylated hemoglobin   NO = nitric oxide   PGF2 = prostaglandin F2   PSS = physiological saline solution   RA = radial artery

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