Oxidative Stress and Nitric Oxide Pathway in Adult Patients Who Are Candidates for Cardiac Surgery: Patterns and Differences

Overview

Journal Interact Cardiovasc Thorac Surg

Publisher Oxford University Press

Specialties Cardiology & Vascular Diseases
General Surgery
Pulmonary Medicine

Date 2013 Sep 10

PMID 24014619

Citations 17

Authors

Viviana Cavalca

Elena Tremoli

Benedetta Porro

Fabrizio Veglia

Veronika Myasoedova

Isabella Squellerio

Daniela Manzone

Marco Zanobini

Matteo Trezzi

Matteo Nicola Dario Di Minno

Jose Pablo Werba

Calogero Tedesco

Francesco Alamanni

Alessandro Parolari

Affiliations

Soon will be listed here.

Abstract

Objectives: We investigated whether oxidative stress and the arginine/nitric oxide pathway differ in control subjects and in adult patients who are candidates for the three most common cardiac surgical operations: coronary bypass surgery, aortic valve replacement for calcific non-rheumatic aortic stenosis or mitral valve repair for degenerative mitral insufficiency.

Methods: In this prospective observational study, we studied 165 consecutive patients undergoing surgery from January to June 2011 (coronary bypass surgery, n = 63; aortic valve replacement for calcific non-rheumatic aortic stenosis, n = 51; mitral valve repair for degenerative mitral insufficiency, n = 51). Thirty-three healthy subjects with cardiovascular risk factors similar to surgery patients were also studied (Controls). Oxidative stress (the ratio of reduced and oxidized glutathione and urinary isoprostane), antioxidants (alpha- and gamma tocopherol) and factors involved in nitric oxide synthesis (arginine, symmetric and asymmetric dimethylarginine) were measured before surgery. Analysis of variance general linear models and principal component analysis were used for statistical analysis.

Results: Surgical patients had increased levels of oxidative stress and decreased levels of antioxidants. Increased levels of nitric oxide inhibitor asymmetric dimethylarginine were detected in surgical candidates, suggesting arginine/nitric oxide pathway impairment. Concerning the differences among surgical procedures, higher oxidative stress and a major imbalance of the ratio between substrate and inhibitors of nitric oxide synthesis were evidenced in patients who were candidates for mitral valve repair with respect to coronary bypass surgery patients and patients with calcific non-rheumatic aortic stenosis.

Conclusions: Patients undergoing cardiac surgery have increased oxidative stress and a trend towards an impaired arginine/nitric oxide pathway with respect to Controls. Patients affected by mitral valve regurgitation show more pronounced perturbations in these pathways. The clinical implications of these findings need to be investigated.

Citing Articles

The Interplay between Perioperative Oxidative Stress and Hepatic Dysfunction after Human Liver Resection: A Prospective Observational Pilot Study.

Primavesi F, Senoner T, Schindler S, Nikolajevic A, Di Fazio P, Csukovich G Antioxidants (Basel). 2024; 13(5).

PMID: 38790695 PMC: 11118143. DOI: 10.3390/antiox13050590.

Influence of Coronary Artery Bypass Grafts on Blood Aminothiols in Patients with Coronary Artery Disease.

Ivanov A, Popov M, Metelkin A, Vasilevich Aleksandrin V, Agafonov E, Kruglova M Metabolites. 2023; 13(6).

PMID: 37367901 PMC: 10305081. DOI: 10.3390/metabo13060743.

Ameliorating Effects of Ginger on Isoproterenol-Induced Acute Myocardial Infarction in Rats and its Impact on Cardiac Nitric Oxide.

Hassanien M J Microsc Ultrastruct. 2020; 8(3):96-103.

PMID: 33282684 PMC: 7703011. DOI: 10.4103/JMAU.JMAU_70_19.

Relationship Between Plasma Osteopontin and Arginine Pathway Metabolites in Patients With Overt Coronary Artery Disease.

Moschetta D, Di Minno M, Porro B, Perrucci G, Valerio V, Alfieri V Front Physiol. 2020; 11:982.

PMID: 32848891 PMC: 7424048. DOI: 10.3389/fphys.2020.00982.

Role of nitric oxide in mediating the cardioprotective effect of agomelatine against isoproterenol-induced myocardial injury in rats.

Khalaf H, Abdalla A, Ahmed A, Abdel-Aziz A Naunyn Schmiedebergs Arch Pharmacol. 2020; 393(10):1809-1823.

PMID: 32399613 DOI: 10.1007/s00210-020-01860-y.

References

Hassinger A, Wainwright M, Lane J, Haymond S, Backer C, Wald E . Elevated preoperative serum asymmetrical dimethylarginine (ADMA) is associated with poor outcomes after pediatric cardiac surgery. Intensive Care Med. 2012; 38(10):1697-704. DOI: 10.1007/s00134-012-2657-2. View

Ochoa J, Vilchez M, Mataix J, Ibanez-Quiles S, Palacios M, Munoz-Hoyos A . Oxidative stress in patients undergoing cardiac surgery: comparative study of revascularization and valve replacement procedures. J Surg Res. 2003; 111(2):248-54. DOI: 10.1016/s0022-4804(03)00106-9. View

Squellerio I, Tremoli E, Cavalca V . Quantification of arginine and its metabolites in human erythrocytes using liquid chromatography-tandem mass spectrometry. Anal Biochem. 2011; 412(1):108-10. DOI: 10.1016/j.ab.2011.01.018. View

Olsen L, Mortensen K, Martinussen T, Larsson L, Baandrup U, Pedersen H . Increased NADPH-diaphorase activity in canine myxomatous mitral valve leaflets. J Comp Pathol. 2003; 129(2-3):120-30. DOI: 10.1016/s0021-9975(03)00019-7. View

Weaver H, Shukla N, Ellinsworth D, Jeremy J . Oxidative stress and vein graft failure: a focus on NADH oxidase, nitric oxide and eicosanoids. Curr Opin Pharmacol. 2012; 12(2):160-5. DOI: 10.1016/j.coph.2012.01.005. View

Miller J, Chu Y, Brooks R, Richenbacher W, Pena-Silva R, Heistad D . Dysregulation of antioxidant mechanisms contributes to increased oxidative stress in calcific aortic valvular stenosis in humans. J Am Coll Cardiol. 2008; 52(10):843-50. PMC: 2748760. DOI: 10.1016/j.jacc.2008.05.043. View

Dyverfeldt P, Kvitting J, Carlhall C, Boano G, Sigfridsson A, Hermansson U . Hemodynamic aspects of mitral regurgitation assessed by generalized phase-contrast MRI. J Magn Reson Imaging. 2011; 33(3):582-8. DOI: 10.1002/jmri.22407. View

Werba J, Cavalca V, Veglia F, Massironi P, De Franceschi M, Zingaro L . A new compound-specific pleiotropic effect of statins: modification of plasma gamma-tocopherol levels. Atherosclerosis. 2006; 193(1):229-33. DOI: 10.1016/j.atherosclerosis.2006.06.020. View

Visser M, Paulus W, Vermeulen M, Richir M, Davids M, Wisselink W . The role of asymmetric dimethylarginine and arginine in the failing heart and its vasculature. Eur J Heart Fail. 2010; 12(12):1274-81. DOI: 10.1093/eurjhf/hfq158. View

10.

Ahmed M, Gladden J, Litovsky S, Lloyd S, Gupta H, Inusah S . Increased oxidative stress and cardiomyocyte myofibrillar degeneration in patients with chronic isolated mitral regurgitation and ejection fraction >60%. J Am Coll Cardiol. 2010; 55(7):671-9. PMC: 3092364. DOI: 10.1016/j.jacc.2009.08.074. View

11.

Ci H, Ou Z, Chang F, Liu D, He G, Xu Z . Endothelial microparticles increase in mitral valve disease and impair mitral valve endothelial function. Am J Physiol Endocrinol Metab. 2013; 304(7):E695-702. DOI: 10.1152/ajpendo.00016.2013. View

12.

Ferrari G, Sainger R, Beckmann E, Keller G, Yu P, Monti M . Validation of plasma biomarkers in degenerative calcific aortic stenosis. J Surg Res. 2010; 163(1):12-7. PMC: 2922427. DOI: 10.1016/j.jss.2010.04.010. View

13.

Parolari A, Loardi C, Mussoni L, Cavallotti L, Camera M, Biglioli P . Nonrheumatic calcific aortic stenosis: an overview from basic science to pharmacological prevention. Eur J Cardiothorac Surg. 2009; 35(3):493-504. DOI: 10.1016/j.ejcts.2008.11.033. View

14.

Cavalca V, Sisillo E, Veglia F, Tremoli E, Cighetti G, Salvi L . Isoprostanes and oxidative stress in off-pump and on-pump coronary bypass surgery. Ann Thorac Surg. 2006; 81(2):562-7. DOI: 10.1016/j.athoracsur.2005.08.019. View

15.

Paparella D, Yau T, Young E . Cardiopulmonary bypass induced inflammation: pathophysiology and treatment. An update. Eur J Cardiothorac Surg. 2002; 21(2):232-44. DOI: 10.1016/s1010-7940(01)01099-5. View

16.

Cavalca V, Minardi F, Scurati S, Guidugli F, Squellerio I, Veglia F . Simultaneous quantification of 8-iso-prostaglandin-F(2alpha) and 11-dehydro thromboxane B(2) in human urine by liquid chromatography-tandem mass spectrometry. Anal Biochem. 2009; 397(2):168-74. DOI: 10.1016/j.ab.2009.10.014. View

17.

Liberman M, Bassi E, Martinatti M, Lario F, Wosniak Jr J, Pomerantzeff P . Oxidant generation predominates around calcifying foci and enhances progression of aortic valve calcification. Arterioscler Thromb Vasc Biol. 2007; 28(3):463-70. DOI: 10.1161/ATVBAHA.107.156745. View

18.

Cagirci G, Cay S, Canga A, Karakurt O, Yazihan N, Kilic H . Association between plasma asymmetrical dimethylarginine activity and severity of aortic valve stenosis. J Cardiovasc Med (Hagerstown). 2010; 12(2):96-101. DOI: 10.2459/JCM.0b013e32833cdcea. View

19.

De Rosa S, Cirillo P, Paglia A, Sasso L, di Palma V, Chiariello M . Reactive oxygen species and antioxidants in the pathophysiology of cardiovascular disease: does the actual knowledge justify a clinical approach?. Curr Vasc Pharmacol. 2009; 8(2):259-75. DOI: 10.2174/157016110790887009. View

20.

Cavalca V, Cighetti G, Bamonti F, Loaldi A, Bortone L, Novembrino C . Oxidative stress and homocysteine in coronary artery disease. Clin Chem. 2001; 47(5):887-92. View