Acute changes in left ventricular diastolic function: Cigarette smoking versus nicotine gum

Abstract

SummaryBackground: Echocardiographic evidence of diastolic dysfunction has been demonstrated during acute cigarette smoking in patients with coronary artery disease. Similar studies in healthy patients have shown conflicting results. Furthermore, it is unclear whether nicotine or some other cigarette-related substance is responsible for these observations.Hypothesis: The purpose of the study was to confirm or refute acute effects of cigarette smoking on diastolic function in healthy patients and to compare diastolic effects of a cigarette to smokeless nicotine delivery (nicotine gum).Methods: In all, 27 healthy volunteers were self-assigned into one of two cohorts. A baseline echocardiogram was performed in all patients. The first cohort proceeded to smoke a cigarette and the second to chew a piece of nicotine gum. Within minutes after exposure, another echocardiogram was performed. Traditional measures of diastolic function were compared before and after substance exposure by paired t-tests.Results: The cigarette cohort showed echocardiographic evidence of diastolic dysfunction after smoking. The E:A ratio (time integral) decreased from 2.95 to 2.22 (p < 0.002). Atrial reversal pulmonary velocity, atrial reversal duration, and color flow propagation all showed statistically significant alterations (p < 0.05). The nicotine gum cohort showed no change in traditional diastolic parameters.

Acute effects of using an electronic nicotine-delivery device (electronic cigarette) on myocardial function: comparison with the effects of regular cigarettes

“…These parameters may explain the differences in diastolic function observed between smokers and electronic cigarette users after smoking and device use. Moreover, a study evaluating the effects of smoking compared to nicotine delivered by gum showed that nicotine alone did not cause acute changes in diastolic function [ 28 ]. It seems that nicotine absorption rate is lower from electronic compared to tobacco cigarette use [ 29 ], even when using new-generation devices [ 30 ]; the difference in haemodynamic response between the two groups may be attributed to this.…”

Acute effects of caffeine and cigarette smoking on ventricular long-axis function in healthy subjects

“…Considering that nicotine gum chewing does not yield any acute change in LV diastolic performance in young healthy individuals [ 30 ], it is likely that the acute effect of smoking on LV diastolic function may not be due to nicotine alone. A potential role of smoke-induced acute impairment in coronary blood flow could be hypothesized [ 26 , 31 ].…”

Primary Prevention of Heart Failure

“…The deleterious effect of tobacco seems to be independent of the form of use; increased risk for cardiovascular diseases is reported in nonsmoking use of tobacco [ 88 ]. There is no “safe” level of smoking; single cigarette may stiffen the left ventricle [ 89 ], and as few as 1 to 4 cigarettes a day double the risk of myocardial infarction [ 90 ]. Mechanisms leading to heart failure in smokers include (i) indirect effects, that is by causing or aggravating comorbidities that are related with heart failure, and (ii) direct effects on the myocardium [ 91 , 92 ].…”