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

BMC Cardiovascular Disorders

Vassilis Voudris¹  Maria Savvopoulou¹  Stamatis Kyrzopoulos¹  Dimitris Tsiapras¹  Konstantinos E Farsalinos¹ 

[1] Department of Cardiology, Onassis Cardiac Surgery Center, Sygrou 356, Kallithea 17674, Greece

关键词: Nicotine;    Tobacco harm reduction;    Diastolic function;    Myocardial function;    Smoking;    Electronic cigarette;   

Others  :  829759
DOI  :  10.1186/1471-2261-14-78

 received in 2013-07-26, accepted in 2014-06-21,  发布年份 2014

【 摘 要 】

Background

Electronic cigarettes have been developed and marketed in recent years as smoking substitutes. However, no studies have evaluated their effects on the cardiovascular system. The purpose of this study was to examine the immediate effects of electronic cigarette use on left ventricular (LV) function, compared to the well-documented acute adverse effects of smoking.

Methods

Echocardiographic examinations were performed in 36 healthy heavy smokers (SM, age 36 ± 5 years) before and after smoking 1 cigarette and in 40 electronic cigarette users (ECIG, age 35 ± 5 years) before and after using the device with “medium-strength” nicotine concentration (11 mg/ml) for 7 minutes. Mitral flow diastolic velocities (E, A), their ratio (E/A), deceleration time (DT), isovolumetric relaxation time (IVRT) and corrected-to-heart rate IVRT (IVRTc) were measured. Mitral annulus systolic (Sm), and diastolic (Em, Am) velocities were estimated. Myocardial performance index was calculated from Doppler flow (MPI) and tissue Doppler (MPIt). Longitudinal deformation measurements of global strain (GS), systolic (SRs) and diastolic (SRe, SRa) strain rate were also performed.

Results

Baseline measurements were similar in both groups. In SM, IVRT and IVRTc were prolonged, Em and SRe were decreased, and both MPI and MPIt were elevated after smoking. In ECIG, no differences were observed after device use. Comparing after-use measurements, ECIG had higher Em (P = 0.032) and SRe (P = 0.022), and lower IVRTc (P = 0.011), MPI (P = 0.001) and MPIt (P = 0.019). The observed differences were significant even after adjusting for changes in heart rate and blood pressure.

Conclusions

Although acute smoking causes a delay in myocardial relaxation, electronic cigarette use has no immediate effects. Electronic cigarettes’ role in tobacco harm reduction should be studied intensively in order to determine whether switching to electronic cigarette use may have long-term beneficial effects on smokers’ health.

Trial registration

Current Controlled Trials ISRCTN16974547

【 授权许可】

   
2014 Farsalinos et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]Ockene IS, Miller NH: Cigarette smoking, cardiovascular disease, and stroke: a statement for healthcare professionals from the American Heart Association. Circulation 1997, 96(9):3243-3247.
• [2]Merry AH, Boer JM, Schouten LJ, Feskens EJ, Verschuren WM, Gorgels AP, van den Brandt PA: Smoking, alcohol consumption, physical activity, and family history and the risks of acute myocardial infarction and unstable angina pectoris: a prospective cohort study. BMC Cardiovasc Disord 2011, 11:13. BioMed Central Full Text
• [3]Rigotti NA, Pipe AL, Benowitz NL, Arteaga C, Garza D, Tonstad S: Efficacy and safety of varenicline for smoking cessation in patients with cardiovascular disease: a randomized trial. Circulation 2010, 121(2):221-229.
• [4]Cobb NK, Byron MJ, Abrams DB, Shields PG: Novel nicotine delivery systems and public health: the rise of the “e-cigarette”. Am J Public Health 2010, 100(12):2340-2342.
• [5]Lichodziejewska B, Kurnicka K, Grudzka K, Malysz J, Ciurzynski M, Liszewska-Pfejfer D: Chronic and acute effects of smoking on left and right ventricular relaxation in young healthy smokers. Chest 2007, 131(4):1142-1148.
• [6]Karakaya O, Barutcu I, Esen AM, Kaya D, Turkmen M, Melek M, Onrat E, Esen OB, Celik A, Kilit C, Saglam M, Kirma C: Acute smoking-induced alterations in Doppler echocardiographic measurements in chronic smokers. Tex Heart Inst J 2006, 33(2):134-138.
• [7]Farsalinos K, Tsiapras D, Kyrzopoulos S, Voudris V: Acute and chronic effects of smoking on myocardial function in healthy heavy smokers: a study of Doppler flow, Doppler tissue velocity, and two-dimensional speckle tracking echocardiography. Echocardiography 2013, 30(3):285-292.
• [8]Farsalinos KE, Romagna G, Tsiapras D, Kyrzopoulos S, Voudris V: Evaluating nicotine levels selection and patterns of electronic cigarette use in a group of "vapers" who had achieved complete substitution of smoking. Subst Abuse 2013, 7:139-146.
• [9]Leontiadis L: Results of Chemical Analyses in NOBACCO Electronic Cigarette Refills. Athens: Mass Spectrometry and Dioxin Analysis Laboratory, National Centre for Scientific Research “Demokritos”; 2009. accessed 11 December 2012
• [10]Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pellikka PA, Picard MH, Roman MJ, Seward J, Shanewise J, Solomon S, Spencer KT, St John Sutton M, Stewart W, American Society of Echocardiography's Nomenclature and Standards Committee; Task Force on Chamber Quantification; American College of Cardiology Echocardiography Committee; American Heart Association; European Association of Echocardiography, European Society of Cardiology: Recommendations for chamber quantification. Eur J Echocardiogr 2006, 7(2):79-108.
• [11]Tei C, Ling LH, Hodge DO, Bailey KR, Oh JK, Rodeheffer RJ, Tajik AJ, Seward JB: New index of combined systolic and diastolic myocardial performance: a simple and reproducible measure of cardiac function: a study in normals and dilated cardiomyopathy. J Cardiol 1995, 26(6):357-366.
• [12]Gaibazzi N, Petrucci N, Ziacchi V: Left ventricle myocardial performance index derived either by conventional method or mitral annulus tissue-Doppler: a comparison study in healthy subjects and subjects with heart failure. J Am Soc Echocardiogr 2005, 18(12):1270-1276.
• [13]Amundsen BH, Helle-Valle T, Edvardsen T, Torp H, Crosby J, Lyseggen E, Støylen A, Ihlen H, Lima JA, Smiseth OA, Slørdahl SA: Noninvasive myocardial strain measurement by speckle tracking echocardiography: validation against sonomicrometry and tagged magnetic resonance imaging. J Am Coll Cardiol 2006, 47(4):789-793.
• [14]Kyriakides ZS, Kremastinos DT, Rentoukas E, Mavrogheni S, Kremastinos DI, Toutouzas P: Acute effects of cigarette smoking on left ventricular diastolic function. Eur Heart J 1992, 13(6):743-748.
• [15]Deanfield JE, Shea MJ, Wilson RA, Horlock P, de Landsheere CM, Selwyn AP: Direct effects of smoking on the heart: Silent ischemic disturbances of coronary flow. Am J Cardiol 1986, 57(13):1005-1009.
• [16]Ambrose JA, Barua RS: The pathophysiology of cigarette smoking and cardiovascular disease: an update. J Am Coll Cardiol 2004, 43(10):1731-1737.
• [17]Gvozdjáková A, Bada V, Sány L, Kucharská J, Krutý F, Bozek P, Trstanský L, Gvozdják J: Smoke cardiomyopathy: disturbance of oxidative processes in myocardial mitochondria. Cardiovasc Res 1984, 18(4):229-232.
• [18]Izzotti A, D'Agostini F, Balansky R, Degan P, Pennisi TM, Steele VE, De Flora S: Exposure of mice to cigarette smoke and/or light causes DNA alterations in heart and aorta. Mutat Res 2008, 644(1–2):38-42.
• [19]Nagueh SF, Appleton CP, Gillebert TC, Marino PN, Oh JK, Smiseth OA, Waggoner AD, Flachskampf FA, Pellikka PA, Evangelisa A: Recommendations for the evaluation of left ventricular diastolic function by echocardiography. Eur J Echocardiogr 2009, 10(2):165-193.
• [20]Korinek J, Wang J, Sengupta PP, Miyazaki C, Kjaergaard J, McMahon E, Abraham TP, Belohlavek M: Two-dimensional strain–a Doppler-independent ultrasound method for quantitation of regional deformation: validation in vitro and in vivo. J Am Soc Echocardiogr 2005, 18(12):1247-1253.
• [21]Pearson JL, Richardson A, Niaura RS, Vallone DM, Abrams DB: E-cigarette awareness, use, and harm perceptions in US adults. Am J Public Health 2012, 102(9):1758-1766.
• [22]Cahn Z, Siegel M: Electronic cigarettes as a harm reduction strategy for tobacco control: a step forward of a repeat of past mistakes? J Public Health Policy 2011, 32(1):16-31.
• [23]Farsalinos KE, Polosa R: Safety evaluation and risk assessment of electronic cigarettes as tobacco cigarette substitutes: a systematic review. Ther Adv Drug Safety 2014, 5(2):67-86.
• [24]Luo J, Hill BG, Gu Y, Cai J, Srivastava S, Bhatnagar A, Prabhu SD: Mechanisms of acrolein-induced myocardial dysfunction: implications for environmental and endogenous aldehyde exposure. Am J Physiol Heart Circ Physiol 2007, 293(6):H3673-H3684.
• [25]Goniewicz ML, Knysak J, Gawron M, Kosmider L, Sobczak A, Kurek J, Prokopowicz A, Jablonska-Czapla M, Rosik-Dulewska C, Havel C, Jacob P III, Benowitz N: Levels of selected carcinogens and toxicants in vapour from electronic cigarettes. Tob Control 2013. Mar 6. [Epub ahead of print]
• [26]Romagna G, Allifranchini E, Bocchietto E, Todeschi S, Esposito M, Farsalinos KE: Cytotoxicity evaluation of electronic cigarette vapor extract on cultured mammalian fibroblasts (ClearStream-LIFE): comparison with tobacco cigarette smoke extract. Inhal Toxicol 2013, 25(6):354-361.
• [27]Farsalinos KE, Romagna G, Allifranchini E, Ripamonti E, Bocchietto E, Todeschi S, Tsiapras D, Kyrzopoulos S, Voudris V: Comparison of the cytotoxic potential of cigarette smoke and electronic cigarette vapour extract on cultured myocardial cells. Int J Environ Res Public Health 2013, 10(10):5146-5162.
• [28]Gembala MI, Ghanem F, Mann CA, Sorrell VL: Acute changes in left ventricular diastolic function: cigarette smoking versus nicotine gum. Clin Cardiol 2006, 29(2):61-64.
• [29]Bullen C, McRobbie H, Thornley S, Glover M, Lin R, Laugesen M: Effects of an electronic nicotine delivery device (e cigarette) on desire to smoke and withdrawal, user preferences and nicotine delivery: randomised cross-over trial. Tob Control 2010, 19(2):98-103.
• [30]Farsalinos KE, Spyrou A, Tsimopoulou K, Stefopoulos C, Romagna G, Voudris V: Nicotine absorption from electronic cigarette use: comparison between first and new-generation devices. Sci Rep 2014, 4:4133.
• [31]Janzon E, Hedblad B: Swedish snuff and incidence of cardiovascular disease: a population-based cohort study. BMC Cardiovasc Disord 2009, 9:21. BioMed Central Full Text
• [32]Siegel MB, Tanwar KL, Wood KS: Electronic cigarettes as smoking-cessation tool: results of an online survey. Am J Prev Med 2011, 40(4):472-475.
• [33]Caponnetto P, Campagna D, Cibella F, Morjaria JB, Caruso M, Russo C, Polosa R: Efficiency and safety of an electronic cigarette (ECLAT) as tobacco cigarettes substitute: a prospective 12-month randomized control design study. PLoS One 2013, 8(6):e66317.
• [34]McQueen A, Tower S, Sumner W: Interviews with "vapers": implications for future research with electronic cigarettes. Nicotine Tob Res 2011, 13(9):860-867.
• [35]Dawkins L, Corcoran O: Acute electronic cigarette use: nicotine delivery and subjective effects in regular users. Psychopharmacology (Berl) 2014, 231(2):401-407.