Chest
Volume 131, Issue 4, April 2007, Pages 1142-1148
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Original Research
Tobacco
Chronic and Acute Effects of Smoking on Left and Right Ventricular Relaxation in Young Healthy Smokers

https://doi.org/10.1378/chest.06-2056Get rights and content

Background

Left ventricular (LV) diastolic dysfunction has been observed in cigarette smokers with coronary artery disease. The aim of the study was to assess LV and right ventricular (RV) diastolic function in healthy, young, and slim smokers before and after smoking one cigarette.

Material and methods

The participants were 66 healthy volunteers (age < 40 years; body mass index < 25 kg/m2): 33 smokers (study group [HS]) and 33 nonsmokers (control group). Echocardiographic examination was done in the HS before smoking one cigarette (HS-1) and after smoking one cigarette (HS-2). To assess diastolic function of LV and RV mitral valve flow (MVF), pulmonary venous flow (PVF) and tricuspid valve flow (TVF) were evaluated.

Results

MVF early to late phase ratio (E/A) was significantly lower in HS-1 and HS-2 than in the control group. The PVF systolic to diastolic phase ratio (S/D) was significantly higher in HS-1 and HS-2 than in the control group. These changes suggest LV diastolic function impairment in the HS, but the MVF pattern remained within the normal range. PVF S/D showed systolic dominance (S/D > 1) typical for impaired LV relaxation and abnormal for this age group. TVF E/A was significantly lower in HS-2 than in HS-1 and control subjects and suggests RV diastolic dysfunction.

Conclusions

The following conclusion are made: (1) MVF and PVF demonstrate LV relaxation impairment in healthy smokers before and after smoking one cigarette; (2) the assessment of PVF is a good method reflecting LV diastolic function changes, even when MVF remains normal; and (3) TVF shows RV relaxation impairment after smoking one cigarette in healthy smokers.

Section snippets

Participants

The inclusion criteria were age < 40 years, BMI < 25 kg/m2, normal BP, and normal parameters of echocardiographic examination (wall thickness, left and right chamber size, valvular function, and left and right ventricular systolic function). All the participants were healthy volunteers with normal results of routine physical examination, chest radiography, standard resting ECG, and routine laboratory tests. The inclusion criteria for smokers were additionally smoking > 10 cigarettes per day

Results

Table 1 shows the characteristics of the study population. The parameters of the physical examination and velocity time integral (VTI) of the pulmonary valve and aortic valve flows reflecting RV and LV stroke volumes25 are shown in Table 2. Only heart rate showed significant difference and was higher in HS-2 than in HS-1 and the control group.

The parameters of LV function are shown in Table 3. MVF E was not significantly lower in HS-1 and HS-2 than in the control group, while MVF A was higher

Discussion

The effects of chronic cigarette smoking are well established. Smoking causes endothelial dysfunction, coronary atherosclerosis, higher heart rate, elevated BP, and may lead to increased myocardial oxygen consumption.152627 The raise in systemic vascular resistance was observed even in otherwise healthy young smokers.28 Acute inhalation of nicotine temporarily decreases nitrate, nitrite, and serum antioxidant concentrations in the plasma29 and is associated with accelerated heart rate and

Conclusions

Conclusions are as follows: (1) changes of MVF and PVF demonstrate impairment of LV relaxation in healthy smokers before and after smoking one cigarette; (2) assessment of PVF is a good method to reflect changes of LV diastolic function, even when MVF remain normal; and (3) changes of TVF indicate that in healthy smokers acute consumption of nicotine causes impairment of RV relaxation.

References (46)

  • KleinAL et al.

    Effects of age on left ventricular dimensions and filling dynamics in 117 normal persons

    Mayo Clin Proc

    (1994)
  • KannelWB et al.

    Contributions of the Framingham study to the conquest of coronary artery disease

    Am J Cardiol

    (1988)
  • GiddingSS et al.

    Cardiac function in smokers and nonsmokers: the CARDIA study

    J Am Coll Cardiol

    (1995)
  • LiH et al.

    Vascular abnormalities in asymptomatic, healthy young adult smokers without other major cardiovascular risk factors: the Bogalusa Heart Study

    Am J Hypertens

    (2005)
  • KleinLW et al.

    Acute hemodynamic response to cigarette smoking in patients with coronary artery disease

    J Am Coll Cardiol

    (1984)
  • JensenJL et al.

    Feasibility of obtaining pulmonary venous flow velocity in cardiac patients using transthoracic pulsed wave Doppler technique

    J Am Soc Echocardiogr

    (1997)
  • Brunner-LaRoccaHP et al.

    Left ventricular end-diastolic pressure can be estimated by either changes in transmitral inflow pattern during Valsalva maneuver or analysis of pulmonary venous flow

    J Am Soc Echocardiogr

    (2000)
  • NaganoR et al.

    Transthoracic Doppler assessment of pattern of left ventricular dysfunction in hypertensive heart disease: combined analysis of mitral and pulmonary venous flow velocity patterns

    J Am Soc Echocardiogr

    (1994)
  • XieX et al.

    Left ventricular diastolic function in young adults: the coronary artery risk development in young adults study

    J Am Soc Echocardiogr

    (1995)
  • HolmgrenSM et al.

    Influence of age, body size and heart rate on left ventricular diastolic indexes in young subjects

    Am J Cardiol

    (1991)
  • YoshifukuS et al.

    Pseudonormalized Doppler total ejection isovolume (Tei) index in patients with right ventricular acute myocardial infarction

    Am J Cardiol

    (2003)
  • YilmazR et al.

    Pulsed wave tissue Doppler-derived myocardial performance index for the assessment of left ventricular thrombus formation risk after acute myocardial infarction

    Am Heart J

    (2004)
  • SeyfarthHJ et al.

    Bosentan improves exercise tolerance and Tei index in patients with pulmonary hypertension and prostanoid therapy

    Chest

    (2005)
  • Cited by (0)

    The work was performed at the Department of Internal Medicine and Cardiology, Institute of Dentistry, Warsaw Medical University, Warsaw, Poland.

    The authors have no conflicts of interest to disclose.

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