The Effects Of Iodixanol And Iohexol On The Circulating Endothelial Microparticles In Coronary Artery Patients With Diabetes Mellitus Undergoing PCI

Background and Aim:Clinically,iso-osmolar contrast media(IOCM)is preferentially chosen over other categories of contrast media for patients with renal dysfunction undergoing Percutaneous Coronary Intervention(PCI),probably because IOCMs are associated with less endothelial damage.Diabetic patients have a higher rate of short-term and long-term adverse cardiovascular events after PCI,compared with non-diabetic patients.Whether this is related to the different degrees of endothelial injury caused by different contrast media(CMs)during PCI has not been reported.We aimed to compare the effects of IOCM iodixanol and low-osmolar contrast media(LOCM)iohexol on circulating endothelial microparticles(EMPs)in patients with stable coronary heart disease(SCAD)and diabetes mellitus(DM)undergoing selective PCI.We also compared the cytotoxic effects of different CMs on human umbilical vein endothelial cells(HUVECs)in vitro.Methods:Part Ⅰ: 100 SCAD patients with DM who were admitted to Department of Cardiology of Xinhua Hospital were randomly divided into iodixanol group(Group I)and iohexol group(Group Ⅱ).Meanwhile,we also recruited 49 SCAD patients without DM as the control group(using iohexol,Group Ⅲ).Flow cytometry was used to measure the absolute counting number of CD31+/CD41a-EMPs,CD62E+ EMPs and CD31+/CD41a+ PMPs(Platelet Microparticles)before and after PCI.Part Ⅱ: CCK-8,flow cytometry,Hoechst staining and Western Blotting were performed to examine the toxicity effects of iodixanol and iohexol on HUVECs in vitro.Results:Part Ⅰ: The levels of CD31+/CD41a-EMPs and PMPs in all three groups after PCI were significantly higher than those of before PCI,while the level of CD62E+ EMPs in group I were significantly decreased.After PCI,CD31+/CD41a-EMPs and PMPs were significantly higher in group Ⅱ than in Group I and Group Ⅲ.Part Ⅱ: In vitro,both IOCM iodixanol and LOCM iohexol caused endothelial cells to release EMPs,inhibited the viability of HUVECs and induced apoptosis,up-regulated Bax and cleaved caspase-3 and down-regulated Bcl-2.The above-mentioned effects of LOCM iohexol are significantly stronger than those of IOCM iodixanol.Conclusions:Compared with iohexol,iodixanol induces less release of EMPs in both SCAD patients with DM during angioplasty and in vitro HUVEC culture,which is associated with less pronounced pro-apoptotic effects of iodixanol on HUVECs.Thus,iodixanol may be superior to iohexol in SCAD patients with DM in coronary angioplasty.