Coronary Arteries In Diabetic Patients Research Articles

Aspects of Coronary Angiography in Diabetic Patients at the CHU Mother and Child Luxembourg in Bamako

<i>Introduction</i>: Type 2 diabetes is on the increase in Africa as a result of the epidemiological transition. Cardiovascular complications, particularly ischemic complications, are common in diabetic patients. They are life-threatening. It is important to identify the angiographic appearance of the coronary arteries in diabetic patients in order to guide treatment. <i>Objective</i>: to identify the results of coronary angiography in diabetic patients. <i>Patients and method</i>: Descriptive, cross-sectional study with retrospective recruitment over a three-year period from September 2019 to August 2022. All diabetic patients who underwent coronary angiography at the CHU mother child Luxembourg in Bamako were included. <i>Results</i>: We enrolled 371 patients out of 985 during the study period, i.e. a hospital frequency rate of 37.66%. The mean age of the patients was 60.76 +/- 10.26 years, with extremes of 32 and 84 years. They were predominantly male, with a sex ratio of 1.45. The predominant functional signs were typical chest pain (39.4%), atypical chest pain (27.8%) and dyspnea (13.2%). The predominant risk factors were hypertension (74.7%), sedentary lifestyle (48.8%) and smoking (17.5%). The indications for coronary angiography were chronic coronary syndrome (55%) and acute coronary syndrome (45%). Coronary angiography was pathological in 78.4% of patients, with tritruncular lesions in 38% and bi-truncal lesions in 21%. Lesions were located on the common trunk in 5.4%, on the anterior interventricular in 59.8%, on the right coronary in 51.8% and on the circumflex in 47.4%. <i>Conclusion</i>: Ischemic heart disease is common in diabetic patients with tri- and bi-truncular lesions.

Disparity in Coronary Artery Diameter in Diabetic and Nondiabetic Subjects undergoing Percutaneous Coronary Intervention in Bangladesh: A 2-Year Retrospective Analysis

Objective: Coronary arteries in diabetic patients were found to be narrower than in non-diabetic subjects. The aim of the study was to compare the coronary arteries diameter between diabetic and non-diabetic patients undergoing percutaneous coronary intervention (PCI) using stent diameter for greater accuracy.Methods: This was a randomized observational study. From a dedicated database, we retrospectively analysed all consecutive patients of both gender who underwent PCI in the cardiac catheterization laboratory of Ibrahim Cardiac Hospital and Research Institute, Dhaka, Bangladesh, from January 2011 to December 2012. Patients who required left main coronary artery stenting were excluded from this study. Patients were divided into two groups; diabetics and non-diabetics. We calculated the coronary artery diameter according to the diameter of the stent, achieved at the final pressure at which the stent was deployed. The diameter which was achieved at a given atmospheric pressure was taken from the attached booklet provided with the stent packaging. If post dilatation was required then the diameter achieved by the non-compliant balloon after post dilatation was taken as the reference diameter of the artery.Results: A total of 571 patients, 333 in diabetic and 238 in non-diabetic group were included in the study. Proximal segments of left anterior descending (LAD) coronary artery in diabetics and non-diabetics were 2.99±0.44 vs 3.14±0.50 mm (p=0.00) while mid and distal segments were 2.90±0.38 vs 3.10±0.42 mm (p=0.00) and 2.25±0.39 vs 2.42±0.45 mm (p=0.00) respectively. Various segments of proximal left Circumflex (LCx) coronary artery in diabetics and non-diabetics were 2.98±0.21 vs 3.01±0.25 mm (p=0.39) while distal circumflex were 2.35±0.40 vs 2.49±0.43 mm (p=0.00) respectively. Proximal segments of right coronary artery (RCA) in diabetic and nondiabetics were 3.0±0.28 vs 3.28±0.25 mm (p=0.00) while mid and distal segments were 2.97±0.26 vs 3.19±0.25 mm (p=0.00) and 2.43±0.51 vs 2.87±0.32 mm (p=0.00) respectively. The number of stents (1.34±0.87 vs 1.30±0.65; p=0.40) and type of stent utilized (DES & non DES: 87.3 & 12.7% vs 85.2 & 14.8%; p=0.50) between diabetic & non-diabetic groups were not significantly different; however the total stent length (23.1±13.3 vs 21.5±9.52 mm; p=0.03) in diabetic group was significantly longer.Conclusions: The diameter of LAD, distal circumflex and right coronary arteries were significantly narrower in diabetic than non-diabetic subjects.Bangladesh Heart Journal 2017; 32(1) : 23-28

Imaging Techniques for the Assessment of Coronary Arteries in Diabetic Patients Undergoing PCI with Bioresorbable Vascular Scaffolds

AbstractPatients who suffer from diabetes mellitus and present coronary artery disease are at a higher risk of cardiovascular events. The coronary arteries of diabetic patients present a diffuse process of atherosclerosis with frequent distal involvement, being prone to acute cardiovascular events. Diabetics present an increased rate of developing coronary artery remodeling, negative remodeling being representative for this class of patients; this process is characterized by vessel shrinkage and an increased rate of coronary calcium accumulation that is a predictor for cardiovascular risk. Currently, it is desired to improve the treatment of diabetic patients with bioresorbable vascular scaffolds (BVS), because of their reduced risk of restenosis and the ability to restore coronary function, including vasomotion, adaptive shear stress, and expansive remodeling. Optical coherence tomography, intravascular ultrasound and multi-slice computed tomography are imaging techniques used for a high accuracy of diagnosis in coronary artery disease. This manuscript is a review that aims to highlight imaging techniques used for evaluating the functional impact of coronary lesions in diabetic patients who underwent coronary PCI with bioresorbable scaffolds and to describe the functional markers that show the specificity for predicting coronary artery disease.

Application of Dual-Source CT Coronary Angiography in Type 2 Diabetic Patients with Symptomatic Coronary Heart Disease.

To evaluate the epidemiological and morphological characteristics of coronary plaque in diabetic patients with symptomatic coronary heart disease (CHD) by dual-source computed tomography (DSCT). From June 2013 to December 2014, 267 consecutive patients with type 2 diabetes mellitus were examined by DSCT. Plaque type, distribution, as well as extent and obstructive characteristics were determined for each segment. A total of 225 patients were included in the final study. Among the 225 cases, patients with calcium score >10 accounted for 76.9%. With the increase in calcium score, the number of obstructive stenoses increased from 17 (22.7%) to 150 (66.4%) segments, and non-obstructive stenosis decreased from 58 (77.3%) to 76 (33.6%) segments. A total of 862 (3.8±3.0 per patient) plaques were detected, of which 448 (52%) were calcified plaque, 272 (32%) mixed plaques and 142 (16%) soft plaques. Regarding the stenosis type, there were significantly more mild (54%), followed by moderate (26%) and severe stenosis (20%); 152 (67.6%) patients had .2 vascular lesions, while 73 (32.4%) patients with single diseased vessel. 190 (84.40%) patients with atherosclerotic plaque were located in left anterior descending (LAD) coronary artery, 146 (64.9%) patients in right coronary artery (RCA), 114 (50.7%) patients in left circumflex (LCX) coronary artery. The most common site of all detected plaques was the proximal segment of the LAD (18.7%). DSCT showed that coronary arteries of diabetic patients with symptomatic CHD were more prone to calcification. There was more non-obstructive than obstructive lumen narrowing; obstructive stenosis and calcification score was positively correlated; coronary plaques were widely distributed, and mainly located in multiple diseased vessels.

Selective Up-Regulation of Arginase-1 in Coronary Arteries of Diabetic Patients

Coronary artery disease (CAD) remains the leading cause of death in the Western societies. Diabetes mellitus (DM) is one of the highly prevalent diseases, which remarkably accelerates the development of CAD. Experimental evidence indicates that decreased bioavailability of coronary endothelial nitric oxide (NO) contributes to the development of CAD in DM. There are recent studies showing that a selective impairment of NO synthesis occurs in coronary arteries of DM patients, which is mainly due to the limited availability of endothelial NO synthase (eNOS) precursor, l-arginine. Importantly, these studies demonstrated that DM, independent of the presence of CAD, leads to selective up-regulation of arginase-1. Arginase-1 seems to play an important role in limiting l-arginine availability in the close proximity of eNOS in vessels of DM patients. This brief review examines recent clinical studies demonstrating the pathological role of vascular arginase-1 in human diabetes. Whether arginase-1, which is crucial in the synthesis of various fundamental polyamines in the body, will represent a potent therapeutic target for prevention of DM-associated CAD is still debated.

Significance of Inflammatory Markers in Diabetic Patients with Stable Coronary Artery Disease

Background/AimsPatients with diabetes are prone to coronary artery disease (CAD); however, the majority of diabetic patients show normal coronary arteries. We examined differences in the clinical aspects of diabetic patients with insignificant and with significant stenosis of the coronary artery.MethodsA total of 418 consecutive diabetic patients with stable angina who had undergone coronary angiography from January 2004 to March 2007 were included in this study. Patients were subdivided into control and CAD groups and then clinical characteristics and CAD-associated factors were evaluated.ResultsA total of 92 (22%) patients were assigned to the control group and 326 (78%) patients were assigned to the CAD group. Using univariate regression analysis, we found that patients with CAD were significantly older (control vs. CAD; 59±21 vs. 64.7±33.7, years, p<0.001), had a longer duration of diabetes (8.2±21.8 vs. 10.2±29.8, years, p=0.027), higher titers of high sensitivity C-reactive protein (hsCRP; 0.3±6.79 vs. 0.9±12.6, mg/dL, p=0.015), and increased hemoglobin A1c (HbA1c) levels (7.1±3.8 vs. 7.5±4.8, %, p=0.007) compared to control patients. Multivariate regression analysis showed that only differences in age, hsCRP, and HbA1c were statistically significant. When patients were subdivided into groups based on hsCRP levels (208 patients in the low group [49.8%], 210 patients in the high group [50.2%]), we found that patients with higher hsCRP levels showed more frequent multivessel disease.ConclusionsIn diabetic patients, age, hsCRP, and HbA1c were associated with stable CAD. Among these factors, hsCRP levels were significantly correlated with multivessel involvement in diabetic CAD. Therefore, high hsCRP levels may be a strong predictor for atherosclerotic progression of the coronary arteries in diabetic patients, suggesting that regular screening tests should be performed.

Abstract 2148: Sirolimus-eluting Stent Versus Bare-metal Stent In Diabetic Patients: Results Of The Italian Multicenter, Randomized “Dessert” Study.

Background: The real benefit of DES in diabetic patients is still debated since few studies have performed a direct randomized comparison between DES and BMS in such a population. Methods : The “Dessert” study is a multicenter, randomized trial conducted in Italy to demonstrate the efficacy of sirolimus-eluting stents (SES) compared to BMS in de novo lesions in native coronary arteries of diabetic patients, treated with insulin and/or oral antidiabetics for at least 3 months. Intraprocedural abciximab or pre-procedural tirofiban were administered to all patients. The primary end point was in-stent late loss as assessed by centralized quantitative coronary angiography at 8-month follow up. Centrally adjudicated composite MACE (death, Q wave and non-Q wave myocardial infarction, emergent bypass surgery or repeat target lesion revascularization) and target vessel failure (TVF: death, treated vessel related AMI, TLR) at 30 days, 9 and 12 months, and binary restenosis 8 months post-procedure were the secondary endpoints. Results: One hundred fifty patients were randomized to SES (75 patients, 109 lesions) or BMS (75 patients, 109 lesions). The two groups were well balanced for clinical, anatomic and procedural characteristics. On average, 45% of patients had multivessel or multilesion PCI, reference diameter was 2.66±0.43 mm and lesion length was 14.9±7.1 mm. In-stent late lumen loss was reduced from 0.96±0.61 mm for BMS to 0.14±0.33 mm for SES (p&lt;0.001); in-segment binary restenosis resulted 38.8% vs 3.6% respectively (p&lt;0.001). Twelve-month clinical events were significantly lower in the sirolimus group: MACE 22.1% vs 38.6%, p=0.035; TLR 5.9% vs 30%, p&lt;0.001; TVF 14.7% vs 34.3%, p=0.008. One case of subacute stent thrombosis occurred in sirolimus group, and one late stent thrombosis in bare-metal group. At multivariable analysis, stent type confirmed as independent predictor of in-segment late loss (p&lt;0.001), binary restenosis (p&lt;0.001), 12 month TVF (p=0.010) and 12-month MACE (p=0.037). Conclusions: The randomized “Dessert” study demonstrated that SES are safe and efficacious in reducing both angiographic and clinical parameters of restenosis compared with BMS in diabetic patients with de novo 1 or 2 vessel coronary stenoses.

Abstract 1680: Spatial Distribution of Myocardial Infarction in Patients with Diabetes Mellitus

BACKGROUND: Acute coronary occlusions occur most frequently as a result of rupture of an atherosclerotic plaque. Previous studies have found greater extent of atherosclerotic disease in the coronary arteries of diabetic patients. While the burden of disease is higher in diabetics, less is known about the spatial distribution of myocardial infarction in this population. METHODS: We sought to compare the spatial distribution of myocardial infarction (STEMI and Non-STEMI) in patients with diabetes mellitus and in those without, based on quantitative coronary and statistical analysis. We analyzed 756 patients with STEMI (n = 556) and NSTEMI (n=200), of which 175 patients comprised the diabetic cohort, and mapped the location of the acute coronary occlusion. RESULTS: Coronary occlusions were not uniformly distributed throughout each of the major epicardial coronary arteries but tended to cluster within the proximal third of each of the vessels in both cohorts. There was no difference in the distribution of occlusions in diabetics vs. non-diabetics in any of the vessels (left anterior descending artery, P=0.35; left circumflex artery; P=0.33 right coronary artery, P=0.20; Figure). CONCLUSIONS: Acute coronary occlusions leading to STEMI and NSTEMI in both diabetics and non-diabetics tend to cluster in predictable “hot spots” within the proximal third of the coronary arteries. Identification of these high-risk zones for acute coronary occlusions will lead to future advances in vulnerable plaque detection technology and potentially locally directed preventive strategies. Spatial distribution of myocardial infarction in diabetics vs. non-diabetics using distance to lesion from the ostium of the coronary artery.

Diagnostic accuracy of multislice computed tomography for the detection of coronary artery disease in diabetic patients

Background Diabetes mellitus is an important risk factor for coronary artery disease. Cardiac multislice computed tomography (MSCT) permits visualization of the coronary arteries with good sensitivity and specificity. However, at present, there are no data whether MSCT allows an accurate assessment of coronary arteries of diabetic patients, in comparison to nondiabetic patients. Thus, we compared the catheter-controlled MSCT results from diabetic and nondiabetic patients in a cohort of 116 patients with regard to sensitivity, specificity, positive predictive value, and negative predictive value, as well as image quality. Methods and Materials Twenty-two diabetic patients (age, 64.6±8.5 years; number of risk factors, 3.4±1.1) and 94 nondiabetic patients (age, 64.2±9.2 years; number of risk factors, 2.4±1.0) were examined by MSCT (Sensation 16 Speed 4 D, Siemens, Forchheim, Germany; gantry rotation time, 375 ms) and invasive coronary angiography. MSCT results were compared, blinded to the results of the coronary angiography with regard to the presence or absence of a significant stenosis (>50%) in a modified American Heart Association 13-segment model. Image quality was assessed on a qualitative scale between 1 (very good) and 5 (invisible) for each segment. Results Sensitivity, specificity, positive predictive value, and negative predictive value were statistically not different in diabetic and nondiabetic patients (0.85/0.98/0.92/0.96 vs. 0.84/0.97/0.91/0.95). One diabetic and three nondiabetic patients had to be excluded from analysis. Diabetic patients had relevantly more risk factors ( P < .05), but calcium scoring was not different in both groups (Agatston score 1090±1278 vs. 798±1033). The image quality in both cohorts was comparable. Conclusions MSCT allows the assessment of the coronary arteries noninvasively in diabetic patients with a good sensitivity and specificity, and diabetes does not have an impact on the number of evaluable segments. Thus, MSCT is a noninvasive tool in the care of these patients.

Randomized blinded clinical trial of intracoronary brachytherapy with 90Sr/Y beta-radiation for the prevention of restenosis after stent implantation in native coronary arteries in diabetic patients

Background We report a double-blind, randomized clinical trial of intracoronary β-radiation for prevention of restenosis after stent implantation in native coronary de novo lesions in diabetic patients. Methods After successful stent implantation in native coronary de novo lesions, 106 lesions in 89 diabetic patients were randomly allocated to treatment with β-radiation with 18 Gy at 1 mm vessel depth ( n=53) or placebo treatment ( n=53). Results Angiographic analysis at 9 month follow-up revealed a late lumen loss of 0.7±0.9 mm in the radiotherapy group versus 1.2±0.8 mm in the control group at the injured segment ( P=0.006), 0.9±1.0 versus 1.3±0.7 mm at the radiated segment ( P=0.02), and 0.9±1.0 versus 1.3±0.7 mm at the target segment ( P=0.04) (defined as active source length plus 5 mm on proximal and distal sites). Binary restenosis rates were significantly lower in the radiation group in all subsegments (injured segment: 10.9 versus 37.3%, P=0.003; radiated segment: 21.7 versus 49.0%, P=0.005; target segment: 23.9 versus 49.0%, P=0.01). Target lesion revascularization for restenosis was required in nine lesions (17.6%) in the radiotherapy group versus 18 (34.0%) in the placebo group ( P=0.05). Late thrombosis occurred in four radiated patients (after premature discontinuation of antiplatelet therapy in all), resulting in a major adverse clinical event rate of 37.2% in the brachytherapy group versus 38.6% in the placebo group ( P=ns). Conclusions In diabetic patients with de novo coronary lesions, intracoronary radiation after stent implantation significantly reduced restenosis. However, this clinical benefit was reduced by the frequent occurrence of late thrombosis.

Coronary Artery Diameter and Left Ventricular Function in Patients on Maintenance Hemodialysis Treatment: Comparison between Diabetic and Nondiabetic Patients

Background/Aims: This study examined the role of diabetes mellitus on determining left ventricular function by evaluating coronary artery diameter in patients with end-stage renal disease on maintenance hemodialysis treatment. Methods: We studied 12 diabetic and 12 nondiabetic patients on maintenance hemodialysis treatment without significant stenoses of the major epicardial coronary arteries. Patients were matched for age, sex distribution, duration of dialysis and incidence of major coronary risk factors. Left ventricular wall thickness (septal and posterior walls) and left ventricular diameter (end-diastolic and systolic phases), were measured by echocardiography. Hemodynamic measurements and coronary angiography were performed on the day of hemodialysis and coronary artery diameter at the proximal and mid portion of three major coronary arteries were measured using the computed densitometry method. Results: Right and left anterior descending and circumflex coronary artery diameters were all significantly smaller and the frequency of coronary artery calcification was higher in diabetic (58%) compared to nondiabetic (8%) patients. Although there were no significant differences in left ventricular wall thickness, left ventricular diameter, mean right atrial pressure and cardiac index between the two groups, left ventricular end-diastolic pressure was significantly higher in diabetic (22 ± 9 mm Hg) compared to nondiabetic patients (14 ± 5 mm Hg). Conclusion: Despite that there were no significant stenoses of the major epicardial coronary arteries, diffuse luminal narrowing of the epicardial coronary arteries in diabetic patients on maintenance hemodialysis treatment was associated with increased left ventricular end-diastolic pressure.

Diffuse Narrowing of Coronary Arteries in Diabetic Patients: The Earliest Phase of Coronary Artery Disease

Coronary arteries in diabetic patients appear to be narrower than in normal subjects, but this has not been examined systematically. To investigate this hypothesis we reviewed the data of 711 consecutive patients with angiographically ‘normal coronary arteries’. Excluded were patients with valvular, myocardial or pericardial disease, and patients with hypertension or hyperlipidemia. Thirteen diabetic patients (10 men) and 22 nondiabetic persons (8 men) constituted the study and control groups, respectively. The diameters of the coronary arteries and their branches were measured and adjusted for body surface area. The sum of the proximal left anterior descending (LAD), circumflex and right coronary arteries (RCA) was calculated and defined as total coronary diameter (TCD). The sum of the distal LAD, first diagonal, first marginal and distal RCA was calculated and defined as total distal coronary diameter (dTCD). The clinical data of both groups were comparable. Adjusted TCD for body surface area was 5.4 ± 1.1 and 6.5 ± 1.1 mm/m² (p < 0.05) in diabetics and nondiabetics, respectively, and adjusted dTCD was 4.9 ± 1.2 and 6.1 ± 1.2 mm/m² (p = 0.01) in diabetics and normal subjects, respectively. Specific arteries and branches that were significantly smaller in diabetics included: left main coronary artery, distal LAD, first diagonal, proximal RCA, distal RCA, right ventricular branch, and posterolateral and posterior descending artery of RCA origin. Gender was not a confounding factor since the control group had a larger proportion of women and still larger arteries than the diabetic group. In conclusion, coronary arteries and their branches in diabetic patients have smaller diameters than normal subjects. This may be due to increased coronary tone, diffuse mild atherosclerosis or both.

G7 Desferrioxamine but not l-arginine improves responses of angiographically normal coronary arteries of diabetic patients to cold pressor test and to flow increase

G7 Desferrioxamine but not l-arginine improves responses of angiographically normal coronary arteries of diabetic patients to cold pressor test and to flow increase

Intravascular Factors in Diabetic Retinopathy

Not all vascular complications of diabetes are specific to this disease. Atherosclerosis of the coronary arteries in diabetic patients does not differ from that in the nondiabetic; it is merely more frequent. Specific, however, are the changes in the microvasculature. It is therefore not surprising that much attention has centered on these changes in diabetic retinopathy. Some of this attention is being currently diverted from vessel wall to vessel content, particularly to the fibrinolytic and clotting systems. It is becoming increasingly apparent that fibrinolytic activity and platelet aggregation may play an important pathogenetic role in the capillary closure, 1 which is one of the earliest manifestations of diabetic retinopathy. The fibrinolytic system is a defensive mechanism against vascular occlusion by platelet plugs and subsequent clots. Paul and Adlakha 2 found this activity to be decreased in two patients with diabetic retinopathy. Fukuda 3 reported similar observations in diabetic patients with