Platelets, endothelium-dependent responses and atherosclerosis

Coronary plaque burden predicts perioperative cardiovascular events after coronary endarterectomy

Background and aims

The risk factors of perioperative and long-term cardiovascular events in patients undergoing coronary artery bypass grafting (CABG) with adjunctive coronary endarterectomy (CE) are not well determined. This study evaluated the clinical value of coronary plaque burden, coronary anatomic stenosis, and serum biomarkers for predicting perioperative cardiovascular events after off-pump CABG + CE.

Methods

This retrospective cohort single-center study enrolled 125 patients undergoing off-pump CABG + CE between February 2018 and September 2021 in China. Coronary plaque burden was reflected by the length of plaque removed by CE. Plaque length-max, which represents the plaque length in patients undergoing single-vessel CE and the maximum plaque length in patients undergoing multivessel CE, was calculated. The primary endpoint was perioperative myocardial infraction (PMI).

Results

Plaque length-max was significantly higher in patients with PMI than in those without PMI (2.4 ± 1.5 vs. 1.6 ± 0.9, p = .001). A threshold plaque length-max of 1.15 cm was an independent predictor of PMI (area under the curve: 0.67; sensitivity 87.9%; specificity 59.8%; p = .005). Patients with plaque length-max ≥1.15 had a > 5-fold increase in PMI after adjusting for confounding factors (odds ratio = 5.89; p = .002). Furthermore, interleukin-6 (Beta = .32: p = .028), CD68 (Beta = .34; p = .045), and osteopontin (Beta = .43; p = .008) were significantly correlated with plaque length-max.

Conclusions

Plaque length-max was superior to clinical cardiovascular risk factors in predicting PMI occurrence after off-pump CABG + CE, which might be associated with systemic and plaque inflammation state.

Vascular effects of isoprostanes after endothelial damage

The isoprostanes, 8-iso-PGF2alpha and 8-iso-PGE2, are powerful vasoconstrictors in vitro and in vivo. Increased formation of 8-iso-PGF2alpha was detected in atherosclerotic patients. In this disease endothelial injuries appear, followed by a reduced release of nitric oxide (NO). Our results show that the vasoconstrictor effects of 8-iso-PGF2alpha as well as of 8-iso-PGE2 were amplified after endothelial damage of the vasculature of the isolated perfused rabbit ear. Also vasoconstrictions induced by both isoprostanes were amplified by perfusions with the NO-synthase blocker N(G)-nitro-L-arginine methylester (L-NAME) at a final concentration of 100 micromol/l. Therefore, we can assume that the amplification of the vasoconstrictor effects of the isoprostanes used after damage of endothelium might be mainly due to the reduced formation of NO.

L-arginine/nitric oxide pathway activation in platelets of migraine patients with and without aura

Nitric oxide (NO) in platelets has been proposed as a promising tool for studying NO variations in migraine. In the present research the platelet response to collagen and the basal and collagen-induced production of NO and cGMP in platelet cytosol were assessed in migraine patients (25 with aura and 35 without aura) both interictally and ictally, and compared with the same parameters in 30 age-matched control subjects. A reduced responsiveness to collagen was found in migraine patients, particularly those with aura, and this was more marked during attacks (ANOVA interictal periods: p < 0.01, attacks: p < 0.02) The basal and collagen-stimulated production of NO and cGMP in the platelet cytosol was significantly higher in migraine patients with aura assessed in interictal periods than in control subjects, and this production was further increased during attacks (interictal period: NO ANOVA: p < 0.001, ictal period: p < 0.01; cGMP: interictal period p < 0.01, ictal period: p < 0.02). The increase in platelet NO and cGMP production was also evident, though to a lesser extent, in migraine patients without aura. The present research supports the hypothesis of an activation of the L-arginine/NO pathway in migraine patients, especially those with aura, and confirms the findings of a previous study of increased levels of L-arginine in platelets of migraine patients studied in headache free-periods, and decreased collagen aggregation in whole blood.

EDRF(NO)-Mediated Modulation of Collagen-Induced Platelet Accumulation in Rat Pulmonary Microcirculation

Endothelium-derived relaxing factor (EDRF) or nitric oxide (NO) biosynthesis from L-arginine occurs in the endothelium and platelets and may modulate platelet function and contribute to thromboresistance in the vessel wall. A rat model was used to evaluate selective accumulation of (III)In-labeled platelets in the pulmonary microcirculation following the administration of collagen, adenosine 5'-diphosphate (ADP) or thrombin. Platelet aggregation was monitored continuously over the thorax using a microcomputer-based system. Sodium nitroprusside, a stimulator of soluble guanylate cyclase and zaprinast, a phosphodiesterase V inhibitor, both known to cause accumulation of cyclic guanosine monophosphate, exhibited moderate inhibitory activity, which was shared by L-arginine. N(G)-monomethyl-L-arginine (L-NMMA; 1 mg/kg/min), an inhibitor of EDRF(NO), potentiated the aggregatory response to collagen at an intravenous dose of 100 &mgr;g/kg but not at one of 30 &mgr;g/kg. D-NMMA had no such effect. The augmenting effect of L-NMMA was abolished by L-arginine. N(G)-nitro-L-arginine methyl ester (L-NAME; 0.1 mg/kg/min) also markedly augmented the collagen-induced platelet response, and, at higher doses, all treated animals died upon collagen challenge. Both L-NMMA and L-NAME did not affect the responses to ADP and thrombin. The results suggest that in the intact vascular system, basal releae of EDRF(NO) is not critically involved in modulation of platelet function but becomes a significant factor when platelets are exposed to great amounts of collagen fibrils. Copyright 1994 S. Karger AG, Basel

Different vascular reactivity of human internal mammary and inferior epigastric arteries in vitro

Vascular responses to endogenous agonists may determine patency rates of bypass graft conduits. The effect of constrictors (noradrenaline, phenylephrine, serotonin, histamine, angiotensin II) and dilators (acetylcholine, substance P, bradykinin, nitroglycerin) were compared in human internal mammary and inferior epigastric arteries in vitro. The latter vessel type has been recently advocated as an additional conduit for coronary artery bypass grafting. Whereas the alpha-adrenoceptor- (noradrenaline, phenylephrine) and serotonin receptor-mediated contractions were similar in both vessels, histamine-induced contractions were greatly enhanced in internal mammary arteries (maximal responses in percent of 80 mmol/L KCl, 131% +/- 15% versus 59% +/- 8%). Maximal contractions in response to angiotensin II were greater in inferior epigastric arteries (50% +/- 6% versus 25% +/- 5%). The endothelium-independent relaxations in response to nitroglycerin were identical in both vessels. In contrast, the endothelium-dependent relaxations in response to acetylcholine, substance P, and bradykinin were significantly greater in the inferior epigastric than in the internal mammary arteries (maximal relaxations expressed as percent of prostaglandin F2 alpha-induced precontraction: acetylcholine, 94% +/- 5% versus 77% +/- 5%; substance P, 85% +/- 4% versus 24% +/- 5%; bradykinin, 77% +/- 5% versus 26% +/- 3%). It is concluded that the inferior epigastric artery has a high endothelial capacity to release endothelium-derived relaxing factor. It appears that the inferior epigastric artery possesses credentials to be successfully used for coronary artery bypass grafting.

Nitric oxide

Nitric oxide is a newly discovered gas that mediates communication between adjacent cells and signals inside cells. Defects in the nitric oxide signalling cascade have been found in patients with systemic hypertension, pulmonary hypertension, and coronary artery disease. High concentrations of nitric oxide are cytotoxic. Over-production of nitric oxide contributes to the pathogenesis of septic shock and uremic bleeding. This review focuses on the cardiovascular and platelet actions of nitric oxide, with emphasis on clinical studies of agents that modulate the nitric oxide signalling cascade.