Abstract
Objective: Type 2 diabetes mellitus is a well-known risk factor in patients with severe coronary artery disease undergoing coronary artery bypass grafting (CABG). The aim of the study was to analyze the endothelial dysfunction in these patients by evaluating postoperative soluble inflammatory cytokines. Methods: Patients undergoing CABG without (n = 15, group A) and with (n = 14, group B) ...
Abstract
Objective: Type 2 diabetes mellitus is a well-known risk factor in patients with severe coronary artery disease undergoing coronary artery bypass grafting (CABG). The aim of the study was to analyze the endothelial dysfunction in these patients by evaluating postoperative soluble inflammatory cytokines. Methods: Patients undergoing CABG without (n = 15, group A) and with (n = 14, group B) diabetes mellitus were analyzed for their release of E-selectin, interleukin-6 (IL-6), and tumor necrosis factor (TNF) up to 3 days postoperatively. A pharmacokinetic quantitative kinetic evaluation (Kinetica 2000) of maximum concentrations (c(max)), time to reach C-max (t(max)), area under the curve (AUC(0-inf)), and terminal elimination half time (t(1/2)) was performed using a non-compartmental model. Results: There was no difference in preoperative plasma concentrations of the cytokines and in the postoperative kinetic analyses of TNF when comparing both groups. However, the release of IL-6 was restricted with cmax of 1055 +/- 543 pg/ml for group B versus 2112 +/- 1532 pg/ml for group A (p < 0.05), paralleled by a decrease in the absolute amount (AUC(0-inf)) of IL-6. The t(1/2) remained unaffected (13.9 +/- 6.6 h and 12.7 +/- 4.6 h, respectively). The AUC(0-inf) of E-selectin decreased by a factor of 1.7 (p < 0.05) with unchanged cmax but reduced t(1/2) (12.9 +/- 10 h for group B vs 33.1 +/- 20.4 h for group A; p < 0.01) referring to an augmented endothelial uptake and degradation of E-selectin. Conclusions: CABG with extracorporeal circulation could be used to verify a specific endothelial dysfunction in diabetic patients characterized by an impaired release of IL-6 and an increased turnover of E-selectin. (c) 2007 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.
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