Assessment of structural and functional myocardial characteristics in patients with chronic coronary artery disease and various glycemic status

Aim. To study the structural and functional myocardial characteristics in patients with exertional angina and type 2 diabetes in comparison with those without diabetes to identify combined hemodynamic changes.

Material and methods. Patients were divided into two groups depen - ding on the glycemic status. The first group consisted of 49 patients (mean age, 57,9±1,04 years; male/female, 35/14) with coronary artery disease (CAD) and type 2 diabetes, while the second one (control)  — 51 patients (60,2±0,9 years, 34/17) with CAD and without diabetes. Patients were surveyed using a standard questionnaire that included socio-demographic parameters, behavioral risk factors, clinical status, medications received, and comorbidities. Diagnostic investigations were carried out, including resting electrocardiography, transthoracic echocardiography and cycle ergometry.

Results. Among patients with CAD and type 2 diabetes, hypertension occurred 20% more often compared with the control group  — 98 vs 78% (p<0,004). According to the electrocardiography, the combination of diabetes and CAD was characterized by various arrhythmias, which were recorded 2,8 times more often than in the group without diabetes. According to echocardiography, signs of left ventricular hypertrophy, systolic and diastolic dysfunction prevailed in people with diabetes. Mean pulmonary artery pressure in patients with diabetes were higher than in patients without carbohydrate metabolism disorders (p<0,004). According to the stress test, exercise tolerance in experimental group patients was lower than in patients in the control group.

Conclusion. The combination of chronic CAD and type 2 diabetes is cha - racterized by a more common combination with hypertension, impaired central and intracardiac hemodynamics, as well as left ventricular hypertrophy. In people with diabetes, impaired systolic and diastolic myocardial function is combined with reduced exercise tolerance.

1. NCD Countdown 2030: worldwide trends in non-communicable disease mortality and progress towards Sustainable Deve - lopment Goal target 3.4. Lancet. 2018;392(10152):1072-88. doi:10.1016/S0140-6736(18)31992-5.

2. Cho NH, Shaw JE, Karuranga S, et al. IDF Diabetes Atlas: Global estimates of diabetes prevalence for 2017 and projections for 2045. Diabetes Res Clin Pract. 2018;138:271281. doi:10.1016/j.diabres.2018.02.023.

3. Ferrannini G, De Bacquer D, De Backer G, et al. EUROASPIRE V collaborators. Screening for Glucose Perturbations and Risk Factor Management in Dysglycemic Patients with Coronary Artery Disease-A Persistent Challenge in Need of Substantial Improvement: A Report From ESC EORP EUROASPIRE V. Diabetes Care. 2020;43(4):726-33. doi:10.2337/dc19-2165.

4. Cosentino F, Grant PJ, Aboyans V, et al. ESC Scientific Document Group, 2019 ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD: The Task Force for diabetes, pre-diabetes, and cardiovascular diseases of the European Society of Cardiology (ESC) and the European Association for the Study of Diabetes (EASD). Eur Heart J. 2020;41(2):255-323. doi:10.1093/eurheartj/ehz486.

5. Oganov RG, Denisov IN, Simanenkov VI, et al. Comorbid pathology in clinical practice. Clinical guidelines. Cardiovascular Therapy and Prevention. 2017;16(6):5-56. (In Russ.) doi:10.15829/1728-8800-2017-6-5-56.

6. Knuuti J, Wijns W, Saraste A, et al. ESC Scientific Document Group. 2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes. Eur Heart J. 2020;41(3):407-77. doi:10.1093/eurheartj/ehz425.

7. Screening for Type 2 Diabetes. Report of a World Health Organization and International Diabetes Federation meeting. Geneva: World Health Organization, 2003, 48 p.

8. Williams B, Mancia G, Spiering W, et al. ESC Scientific Document Group, 2018 ESC/ESH Guidelines for the management of arterial hypertension: The Task Force for the management of arterial hypertension of the European Society of Cardiology (ESC) and the European Society of Hypertension (ESH). Eur Heart J. 2018;39:3021-104. doi:10.1093/eurheartj/ehy339.

9. Einarson TR, Acs A, Ludwig C, et al. Prevalence of cardiovascular disease in type 2 diabetes: a systematic literature review of scientific evidence from across the world in 2007-2017. Cardiovasc Diabetol. 2018;17(1):83. doi:10.1186/s12933-018-0728-6.

10. Heintjes EM, Houben E, Beekman-Hendriks WL, et al. Trends in mortality, cardiovascular complications, and risk factors in type 2 diabetes. Neth J Med. 2019;77(9):317-29.

11. Dedov II, Shestakova MV, Vikulova OK, et al. Diabetes mellitus in the Russian Federation: prevalence, morbidity, mortality, parameters of carbohydrate metabolism and the structure of antihyperglycemic therapy according to the Federal Register of Diabetes Mellitus, status 2017. Diabetes. 2018;21(3):144-59. (In Russ.) doi:10.14341/DM9686.

12. Mekhdiev SK, Mustafaev II, Mamedov MN. Peculiarities of glycemic status and risk factors in patients with ischemic heart disease and type 2 diabetes mellitus in the Azerbaijani population. Russian Journal of Cardiology. 2019;(6):85-91. (In Russ.) doi:10.15829/1560-4071-2019-6-85-91.

13. Fox CS, Sullivan L, D’Agostino RB, et al. Framingham Heart Study. The significant effect of diabetes duration on coronary heart disease mortality: the Framingham Heart Study. Diabetes Care. 2004;27(3):704-8. doi:10.2337/diacare.27.3.704.

14. Das RN. Relationship between Diabetes Mellitus and Coronary Heart Disease. Curr Diabetes Rev. 2016;12(3):285-96. doi:10.2174/1573399812666160105111811.

15. Tatarchenko IP, Pozdnyakova NV, Denisova AG, et al. Clinical and instrumental analysis of ventricular arrhythmias in diastolic heart failure in patients with type 2 diabetes mellitus. Endocrinology problems. 2015;2:21-7. (In Russ.) doi:10.14341/probl201561221-27.

16. Nuzhdina EV, Davydova EV. Features of dysregulation of the pacemaker activity of the sinus node of the heart in patients with ischemic heart disease, diabetes mellitus and a combination of these pathologies. Perm Medical Journal. 2016;33(6):17-23. (In Russ.)

17. Zhao Z, Hou C, Ye X, et al. Echocardiographic Changes in Newly Diagnosed Type 2 Diabetes Mellitus Patients with and without Hypertension. Med Sci Monit. 2020;26:e918972-1-e918972-8. doi: 10.12659/MSM.918972.

18. Golukhova EZ, Mustafaeva AZ. The effect of type 2 diabetes mellitus on the diastolic function of the left ventricular myocardium in patients with coronary heart disease. Creative Cardiology. 2013;2:46-52. (In Russ.)

19. Sharda M, Soni AK, Meena S, et al. A Prospective Study on Utility of Exercise Treadmill Test in Type 2 Diabetes Mellitus Patients. J Assoc Physicians India. 2016;64(11):32-7. doi:10.18203/2349-3933.ijam20211055.

20. Prasad DS, Kabir Z, Revathi Devi K, et al. Prevalence and RIsk factors for Silent Myocardial ischemia (PRISM): A clinico observational study in patients of type 2 diabetes. Indian Heart J. 2019;71(5):400-5. doi:10.1016/j.ihj.2019.12.002.