Impact of reversible myocardial ischaemia on nitric oxide and asymmetric dimethylarginine production in patients with high risk for coronary heart disease
Marina Deljanin Ilic, Stevan Ilic, Gordana Lazarevic, Gordana Kocic, Radmila Pavlovic, Vladisav Stefanovic
Med Sci Monit 2010; 16(9): CR397-404
Available online: 2010-08-07
Background: The aim of the present study was to assess the impact of reversible myocardial ischemia, provoked by acute physical activity during an exercise stress echocardiography (ESE), on nitric oxide (NOx) and asymmetric dimethylarginine (ADMA) production in patients with high risk for coronary heart disease (CHD).
Material/Methods: An overall of 45 patients (27 men, 18 women; mean age, 55.87±6.39 years), was enrolled in the study and assigned into groups according to sex, CHD risk factors (RF), wall motion score (WMS), and diabetes mellitus (DM). An ESE was performed on an ergocycle, using a standardized protocol. The modified Saville-Griess method was used to determine NOx concentration. Production of ADMA was evaluated by high-performance liquid chromatography with fluorescent detection.
Results: A significant increase of NOx was observed in men (P<.05) and patients with stable WMS (P<.01), as well as its decrease in patients with increased WMS, whereas ADMA significantly increased in both sexes (P<.001 and P<.01 in men and women, respectively), independently of CHD risk (P<.05 and P <.001 in 1–2 RF and ≥3 RF groups, respectively), presence of DM (P<.001 and P<.01 in no-DM and DM groups, respectively), and WMS dynamic (P<.05 and P<.001 in WMS stable and WMS increased groups, respectively). The WMS was significantly higher in the ≥3 RF group (P<.01) after ESE and significantly increased in both sexes (P<.001 and P<.01 in men and women, respectively), with no regard to DM (P<.001 and P<.01 in no-DM and DM groups, respectively).
Conclusions: The results of the present study clearly demonstrated a significant increase of NOx in patients with stable WMS and its decrease in patients with increased WMS after ESE, compared with the resting condition, as well as a significant increase of ADMA both in patients with stable WMS and those with increased WMS, irrespective of sex and CHD risk. A significant increase of WMS was observed in the ≥3 CHD RF group, in both sexes, with no regard to the presence of DM.
Keywords: Exercise Tolerance - physiology, Diabetes Complications - physiopathology, Coronary Disease - ultrasonography, Arginine - biosynthesis, Nitric Oxide - biosynthesis, Risk Factors