Effect of hyperoxia and vitamin C on coronary blood flow in patients with ischemic heart disease

Abstract

Pathological formation of reactive oxygen species within the coronary circulation has been hypothesized to mediate some clinical manifestations of ischemic heart disease (IHD) by interfering with physiological regulation of coronary tone. To determine the degree to which coronary tone responds to acute changes in ambient levels of oxidants and antioxidants in vivo in a clinical setting, we measured the effect of an acute oxidative stress (breathing 100% oxygen) on coronary capacitance artery diameter (quantitative angiography) and blood flow velocity through the coronary microcirculation (intracoronary Doppler ultrasonography) before and after treatment with the antioxidant vitamin C (3-g intravenous infusion) in 12 IHD patients undergoing a clinical coronary interventional procedure. Relative to room air breathing, 100% oxygen breathing promptly reduced coronary blood flow velocity by 20% and increased coronary resistance by 23%, without significantly changing the diameter of capacitance arteries. Vitamin C administration promptly restored coronary flow velocity and resistance to a slightly suprabasal level, and it prevented the reinduction of coronary constriction with rechallenge with 100% oxygen. This suggests that acute oxidative stress produces prompt and substantial changes in coronary resistance and blood flow in a clinical setting in patients with IHD, and it suggests that these changes are mediated by vitamin C-quenchable substances acting on the coronary microcirculation. This observation may have relevance for clinical practice.

Perioperative Oxygen Toxicity

“…Coronary artery resistance was increased by 23% when breathing 100% oxygen, and the effect was also abolished by infusion of vitamin C. 40 …”

Paradigms of Oxygen Therapy in Critically Ill Patients

“…However, potentially harmful mechanisms include the paradoxical effect of oxygen in reducing coronary artery blood flow and increasing coronary vascular resistance [29,30] reducing stroke volume and cardiac output and the consequent reperfusion injury from increased oxygen free radicals [31,32].…”

Oxygen for ST-Segment–Elevation Myocardial Infarction

“…6 More recent studies have called this routine practice into question, with a similar signal toward more negative outcomes. 7 Adverse physiological effects of supplemental oxygen related to increasing coronary vascular resistance and generation of reactive oxygen species have been described, 8,9 fueling the need for an adequately powered randomized, clinical trial. 7 In this issue of Circulation, Stub and colleagues 10 sought to determine the relationship between supplemental oxygen compared with no oxygen therapy with infarct size in normoxic patients with STEMI undergoing primary PCI within the Air Versus Oxygen Myocardial Infarction (AVOID) study.…”