Influence of transradial versus transfemoral diagnostic heart catheterisation on peripheral vascular endothelial function

Abstract

Aims: Endothelium dysfunction has been reported in patients (pts) undergoing transradial catheterisation. Alterations of the hand microcirculation possibly associated with systemic inflammation have never previously been reported. We aimed at investigating possible alteration of hand endothelial microcirculation secondary to transradial heart catheterisation.

Methods and results: We randomised 40 pts with stable angina undergoing coronary angiography to either transradial (TR, n=20) or transfemoral (TF, n=20) approach. At baseline (BL), 24 hours (24 hrs) and 30 days (FU: follow-up) after catheterisation we assessed: a) peripheral endothelial function (EndoScore [ES]) by peripheral arterial tonometry (EndoPAT); b) biomarkers of endothelial turnover (sE-Selectin) and inflammation (hs-CRP). No clinical or angiographic differences were observed between the two groups. At 24 hours, ES (BL: 0.42±0.27 vs. 24 hours: 0.27±0.19, p<0.05) significantly decreased in the TR group, but not in the TF group (BL: 0.44±0.34 vs. 24 hours: 0.45±0.39, n.s.). Both sE-Selectin and hs-CRP increased significantly at 24 hours in all pts. At 30 days, we observed in the TR group a restoration of ES (FU: 0.44±0.34, n.s. vs. BL; p<0.05 vs. 24 hours), while no difference was observed in the TF group. A reduction towards baseline was observed in both groups of sE-Selectin and hs-CRP.

Conclusions: A transient impairment of the digital microcirculatory endothelial function is observed in patients undergoing transradial diagnostic catheterisation, beyond local mechanical injury at the arterial access and on top of the systemic inflammatory response associated with heart catheterisation.