Abstract
BackgroundBoth the progression of diabetic kidney disease and increased glycemic variability play important roles in the pathogenesis of coronary plaque formation via inflammatory pathways in patients with type 2 diabetes mellitus (T2DM). Therefore we evaluated the role of renal function in the contributory effects of blood glucose fluctuations and blood levels of inflammatory cytokine concentrations on the tissue characteristics of coronary plaques in patients with T2DM.MethodsWe prospectively enrolled 71 T2DM patients (mean age: 68 ± 9, male 79%) with 153 coronary artery lesions. Patients were divided into 2 groups according to their estimated glomerular filtration rate (eGFR) levels: Group 1 (≥ 60 mL/min/1.73 m2, n = 40) and Group 2 (< 60 mL/min/1.73 m2, n = 31). All patients underwent continuous glucose monitoring (CGM) for 120 h and the mean amplitude of glycemic excursions (MAGE) was calculated. Serum tumor necrosis factor (TNF)-α was also measured. In addition, gray-scale coronary intravascular ultrasound (IVUS) and iMap-IVUS were performed in the coronary lesions with < 50% luminal reduction.ResultsIn Group 1, MAGE correlated with percent lipidic volume (%LV) (r = 0.477, p = 0.002). In this group, stepwise multivariate linear regression analyses showed that only MAGE was independently associated with %LV (β = 0.477, p = 0.002). In contrast, in Group 2, only serum TNF-α correlated with percent fibrotic volume (%FV) (r = − 0.471, p = 0.007), %LV (r = 0.496, p = 0.005) and percent necrotic volume (%NV) (r = 0.426, p = 0.017). In this group, stepwise multivariate linear regression analyses showed that only serum TNF-α was independently associated with each tissue characteristic (%FV β = − 0.471 and p = 0.007, %LV β = 0.496 and p = 0.005, %NV: β = 0.426 and p = 0.017).ConclusionsIn T2DM patients, the tissue characteristics of coronary plaques were associated with MAGE in patients with eGFR ≥ 60 mL/min/1.73 m2 and with serum TNF-α in those with eGFR < 60 mL/min/1.73 m2.
Highlights
Glycemic variability plays an important role in coronary plaque formation mainly via inflammatory pathways in Kakuta et al Cardiovasc Diabetol (2017) 16:131 atheromatous plaques
We divided the patients into two groups according to their estimated glomerular filtration rate (eGFR) levels: Group 1 (≥ 60 mL/ min/1.73 m2, n = 40) and Group 2 (< 60 mL/min/1.73 m2, n = 31)
The present study revealed that the factors that contribute to the tissue characteristics of coronary plaques differ depending on the renal function of patients with type 2 diabetes mellitus (T2DM)
Summary
Glycemic variability plays an important role in coronary plaque formation mainly via inflammatory pathways in Kakuta et al Cardiovasc Diabetol (2017) 16:131 atheromatous plaques. IMapIVUS is the most recent radiofrequency-IVUS system to incorporate a 40-MHz rotating single element catheter [6] It can classify coronary plaques into fibrotic, lipidic, necrotic or calcified components using spectral radiofrequency analysis with a classification algorithm generated from ex vivo histological findings [6, 7]. The aim of the present study was to determine whether the factors that contribute to the tissue characteristics of coronary plaques differ depending on renal function in patients with T2DM using iMap-IVUS. Both the progression of diabetic kidney disease and increased glycemic variability play important roles in the pathogenesis of coronary plaque formation via inflammatory pathways in patients with type 2 diabetes mellitus (T2DM). We evaluated the role of renal function in the contributory effects of blood glucose fluctuations and blood levels of inflammatory cytokine concentrations on the tissue characteristics of coronary plaques in patients with T2DM
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