Poorly Controlled Hypertension Alters Coronary Microvascular Contractile Response to Endothelin‐1 Before and After Cardiac Surgery

Authors:
Publisher website
Google Scholar
Abstract
Background: Patients with chronic hypertension have worse outcomes following on‐pump (cardioplegia and cardiopulmonary bypass [CP/CPB]) cardiac surgery. Altered vasomotor function of the coronary microvasculature to ET‐1 (endothelin‐1) and other agonists may underlie these differences. Methods: Heart samples were collected from 85 patients undergoing CP/CPB enrolled in this observational study. Ex vivo coronary microvascular responses to ET‐1, adenosine diphosphate, and sodium nitroprusside were assessed using video microscopy. Immunoblotting, immunohistochemistry, enzyme‐linked immunosorbent assay, and multiomics approaches were also used. Results: Coronary microvascular contractile response to ET‐1 in patients with uncontrolled hypertension was increased compared with the other 2 cohorts pre‐ and post‐CP/CPB ( P −10 to 10 −7 mmol/L). Adenosine diphosphate‐induced coronary microvascular vasodilation was conversely decreased ( P −5 and 10 −4 mmol/L). Post‐CP/CPB microvascular responses to ET‐1 and adenosine diphosphate were blunted overall ( P A receptor diminished contractile response ( P 2 0.95 pre‐CP/CPB, R 2 0.86 post‐CP/CPB), which, in turn, estimated change in ejection fraction pre‐ and post‐CP/CPB ( P P <0.05). Conclusions: Altered coronary microvascular vasomotor function in patients with uncontrolled hypertension may jeopardize myocardial perfusion. Hypertension status and cardiac mass may be used to prognosticate this physiology, which, in turn, estimates change in ejection fraction postoperatively. Perioperative endothelin receptor blockers may benefit patients with uncontrolled hypertension and thus warrant further investigation.

This publication has 43 references indexed in Scilit: