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Eur J Cardiothorac Surg 2007;32:611-616. doi:10.1016/j.ejcts.2007.06.027
Copyright © 2007, European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved

Endothelial cell dysfunction after coronary artery bypass grafting with extracorporeal circulation in patients with type 2 diabetes mellitus

Karla Lehle1,*, Jürgen G. Preuner1, Anja Vogt, Leopold Rupprecht, Andreas Keyser, Reinhard Kobuch, Christof Schmid, Dietrich E. Birnbaum

Department of Cardiothoracic Surgery, University Hospital Regensburg, 93042 Regensburg, Germany

Received 30 April 2007; received in revised form 21 June 2007; accepted 22 June 2007.

* Corresponding author. Address: Department of Cardiothoracic Surgery, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, D-93053 Regensburg, Germany. Tel.: +49 941 9449901; fax: +49 941 9449902. (Email: Karla.Lehle{at}klinik.uni-regensburg.de).

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 (AUC0–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 c max 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 (AUC0–inf) of IL-6. The t 1/2 remained unaffected (13.9 ± 6.6 h and 12.7 ± 4.6 h, respectively). The AUC0–inf of E-selectin decreased by a factor of 1.7 (p ≤ 0.05) with unchanged c max 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.

Key Words: Endothelial dysfunction • Diabetes mellitus • Coronary artery bypass grafting • Cytokines






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Copyright © 2007 European Association for Cardio-Thoracic Surgery. Published by Elsevier. All rights reserved.