Autonomic and endothelial dysfunction with neurocirculatory asthenia in young men of call-up age

Young men of call-up age with neurocirculatory were asthenia were examined for autonomic regulation of cardiac activity and vasodilatory reserve of the arteries. The functional state of the autonomic nervous system (ANS) was studied with the aid of rythmography with analyse of heart rate variability. The following parameters were studied: vegetative regulation type, responsiveness of departments of ANS and autonomic provision of cardiac activity. The type of vegetative regulation was determined by the mean value of RR interval and indication of the heart rate variability (∆RR). Reactivity of parasympathetic and sympathetic divisions of the ANS and autonomic support of cardiac activity were investigated using breathing test. To ensure vegetative dysadaptation cardiac activity includes reaction with low vegetative coverage of both divisions of the ANS and paradoxical reaction in which there is a decrease in ∆RRmax (instead of increase) and an increase in ∆RRmin instead of decrease. These reactions indicate autonomic dysfunction. Vasodilatory reserve of the arteries was investigated using ultrasonography of the brachial artery with compressive sample and determination of endothelium-dependent vasodilation. It was found that in boys with neurocirculatory asthenia vagotonic and sympathetic types of vegetative regulation are often determined by disadaptative vegetative provision of cardiac activity, which is accompanied by endothelial dysfunction with reduced vasodilator reserve of the arteries.

Effects of Ischemic Reperfusion Injury and Remote Conditioning on Passive Leg Raising-Induced Brachial-Artery Dilation

Objectives: Passive leg raising (PLR) has been proposed to assess arterial vasodilator reserve and possibly endothelial function. Since endothelial function is sensitive to ischemic-reperfusion (I-R) injury, we determined the effects of I-R injury and ischemic conditioning on PLR-induced brachial-artery dilation (BAD), i.e. PLR-BAD. Methods: We induced PLR-BAD before and after ipsilateral arm I-R injury (7.5 min of occlusion) in 20 healthy males aged 29 ± 6 years. The protocol was repeated in combination with remote conditioning stimuli (3 × 30 s of contralateral arm occlusions). Results: PLR resulted in significant BAD (3.85%, p < 0.001) before but not after prolonged ischemia (0.25%, p = 0.38). I-R injury, along with either preischemic or postischemic conditioning restored the PLR-BAD response (before: 3.11%, p < 0.001 and after: 3.74%, p < 0.001). Conclusions: I-R injury blunts the BAD induced by PLR. Remote pre- and postconditioning restore this response. These findings are similar to those previously reported using hyperemia and ultrasound to assess BAD.

Abstract 3249: Late Endothelial Function of Bilateral Internal Thoracic Arteries Used as a Y-graft Configuration

The manner in which a blood vessel is harvested for use as a coronary graft may be important in maintaining a viable and functional endothelial lining. Internal thoracic arteries (ITA), when used as a Y-graft configuration are characterized by the connection of a pedicled left ITA with preserved innervation and lymphatics and of a free skeletonized right ITA. To determine whether endothelial function differs between left and right ITA segments in a Y-graft configuration, 11 patients were studied 3 years after surgery. The endothelial-dependent vasodilator substance P was selectively infused (1.4 up to 22.4 pmol/min in doubling dose increments) in the ostium of ITA Y-grafts. A maximal endothelium-independent vasodilatory response was obtained by intragraft infusion of 2 mg isosorbide dinitrate (ISDN). Biplane angiograms obtained at 3 minutes intervals using an automated contrast injection system with fixed pre-set volume and pressure parameters were analyzed off-line using a quantitative analysis system (CAAS, Pie Medical). A similar dose-dependent vasodilatory response to substance P was observed in the left and in the right ITA (figure ). No difference in maximal endothelium-dependent response to substance P (7.4±4.3% in left ITA and 8.1 ± 5.3% in right ITA) or in maximal endothelium-independent response to ISDN (12.2 ± 4.4% in left ITA and 10.6 ± 8.1% in right ITA) was observed. In conclusion, the endothelial function and the vasodilator reserve of the two branches of a Y-graft ITA configuration appear similar 3 years after bypass surgery. This suggests that the preservation of the ITA pedicle does not significantly affect basal vasomotor tone or long-term endothelial function.