scholarly journals Endostatin and angiostatin are increased in diabetic patients with coronary artery disease and associated with impaired coronary collateral formation

2009 ◽  
Vol 296 (2) ◽  
pp. H428-H434 ◽  
Author(s):  
Neel R. Sodha ◽  
Richard T. Clements ◽  
Munir Boodhwani ◽  
Shu-Hua Xu ◽  
Roger J. Laham ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Molecular Mechanisms ◽  
Artery Bypass ◽  
Cathepsin L ◽  
Tissue Inhibitor Of Metalloproteinase ◽  
Diabetic Patients ◽  
Collagen Xviii ◽  
Incomplete Revascularization ◽  
Artery Disease

Coronary artery disease (CAD) is the leading cause of mortality in diabetic patients. Because of the diffuse nature of their disease, diabetic patients may be at risk for incomplete revascularization, highlighting a potential role for proangiogenic therapy in this group. This study investigates molecular mechanisms of angiogenesis in diabetic patients. Myocardial tissue was harvested from patients undergoing coronary artery bypass grafting [nondiabetic (ND) 11, type 2 diabetic (DM) 10]. Expression of angiostatin, endostatin, their precursors (plasminogen and collagen XVIII, respectively), enzymes leading to their production [matrix metalloprotease (MMP)-2 and -9, cathepsin L], and an inhibitor of MMPs (tissue inhibitor of metalloproteinase) was assessed with Western blotting. MMP activity was assessed. Coronary collateralization was graded by Rentrop scoring of angiograms. Plasminogen and collagen XVIII expression were similar between groups. Angiostatin expression trended to increase 1.24-fold ( P = 0.07), and endostatin expression increased 2.02-fold in DM patients relative to ND ( P = 0.02). MMP-9 expression was no different between groups, whereas MMP-2 expression decreased 1.8-fold in diabetics ( P = 0.003). MMP-2 and -9 activity decreased 1.33-fold ( P = 0.03) and 1.57-fold ( P = 0.04), respectively, in diabetic patients. Cathepsin L expression was 1.38-fold higher in diabetic patients ( P = 0.02). Coronary collateralization scores were ND 2.1 ± 0.37 vs. DM 1.0 ± 0.4 ( P = 0.05). Myocardial endostatin expression correlated strongly with the percentage of hemoglobin A1c ( r = 0.742, P = 0.0001). Myocardial expression of angiostatin and endostatin demonstrated significant negative linear correlations with coronary collateralization (angiostatin r = −0.531, P = 0.035, endostatin r = −0.794, P = 0.0002). Diabetic patients with CAD exhibit increased levels of the antiangiogenic proteins angiostatin and endostatin and differential regulation of the enzymes governing their production relative to ND patients. Myocardial levels of these proteins show significant correlation to coronary collateralization. These findings offer potential new therapeutic targets for enhancing proangiogenic therapy and insight into the angiogenic impairments seen in diabetes.

Abstract 1742: Expression of the Anti-Angiogenic Proteins Angiostatin and Endostatin is Increased in Diabetic Patients and Associated with Impaired Coronary Collateral Formation

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Neel R Sodha ◽  
Munir Boodhwani ◽  
Richard T Clements ◽  
Shu-Hua Xu ◽  
Roger L Laham ◽  
...  
Keyword(s):  
Molecular Mechanisms ◽  
Serum Levels ◽  
Diabetic Patients ◽  
Angiogenic Therapy ◽  
Collagen Xviii ◽  
Mmp9 Expression ◽  
Angiogenic Proteins ◽  
Incomplete Revascularization ◽  
Artery Disease

Introduction: Coronary artery disease is the leading cause of mortality in diabetics. Due to the diffuse nature of their disease, diabetics may be at risk for incomplete revascularization, highlighting a potential role for pro-angiogenic therapy in this group. This study investigates molecular mechanisms of angiogenesis in diabetics. Methods: Myocardial tissue was harvested from patients undergoing CABG (non-diabetic (ND) 11, type 2 diabetic (DM) 10). Expression of angiostatin, endostatin, their precursors (plasminogen and collagen XVIII, respectively), enzymes leading to their production (Matrix Metalloprotease (MMP) 2 & 9), and an inhibitor of MMPs (TIMP2) was assessed with western blotting. MMP activity was assessed. Serum levels of angiostatin and endostatin were assayed. Coronary collateralization was graded by Rentrop scoring of angiograms. Results: Plasminogen and collagen XVIII expression were similar between groups. Angiostatin expression trended to increase 1.24-fold (p=0.07) and endostatin expression increased 2.02-fold in DM patients relative to ND (p=0.02). Serum angiostatin was 2.68-fold higher (p=0.03) and endostatin 1.39-fold higher (p=0.04) in diabetics. MMP9 expression was no different between groups, whereas MMP2 expression decreased 1.8-fold in diabetics (p=0.003). MMP2 & 9 activity decreased 1.33-fold (p=0.03) and 1.57-fold (p=0.04), respectively, in diabetics. Coronary collateralization scores were ND 2.1 ± 0.37 vs. DM 1.0 ± 0.4 (p=0.05). Myocardial endostatin expression correlated strongly with %HbA1c (R=0.742, p=0.0001). Myocardial expression of angiostatin and endostatin demonstrated significant negative linear correlations with coronary collateralization (angiostatin R=−0.531, p=0.035, endostatin R=−0.794, p=0.0002). Conclusion: Diabetics exhibit increased levels of the anti-angiogenic proteins angiostatin and endostatin and differential regulation of the enzymes governing their production relative to non-diabetics. Myocardial levels of these proteins show significant correlation to coronary collateralization. These findings offer potential new therapeutic targets for enhancing pro-angiogenic therapy and insight in to the angiogenic impairments seen in diabetes.

scholarly journals Multivessel Coronary Artery Disease in Diabetes Mellitus Patients

2019 ◽  
Vol 4 (2) ◽  
pp. 121-127
Author(s):  
Amanj Kamal Mohammed
Keyword(s):  
Diabetes Mellitus ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Coronary Artery Bypass Graft ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Diabetic Patients ◽  
Artery Bypass Graft ◽  
Artery Disease

Coronary artery disease is the most common cardiac disease with a worldwide distribution, and it is responsible for most of the mortalities regarding cardiovascular diseases if not detected early and treated properly. There are many lines in the treatment of coronary artery disease, starting from medical therapy, percutaneous coronary intervention, and coronary artery bypass graft surgery, preference of the choice of the type of the treatment depends on many factors. In fact when coronary artery bypass graft is indicated, although it carries a considerable risk of surgery, but the long-term survival is notably better than the other ways of treatment. This study was done to determine that the prevalence of multivessel coronary artery disease is more in diabetic patients than non-diabetic patients. And more in females than males. In this study hundred, ninety patients were retrospectively studied, all of them underwent coronary artery bypass graft surgery with or without other concomitant cardiac procedures (like valve surgery), but most of them were coronary artery bypass graft alone. We found that the number of coronary arteries affected is strongly related to the presence of diabetes mellitus. And females are more prone to have coronary artery disease than males. Thus diabetes mellitus is the most common risk factor for the development of cardiovascular disease, and the severity of the condition is confirmed by the number of the coronary arteries involved as well as the calcification or multiple stenosis in the same vessel.

scholarly journals Improved Survival in Asymptomatic Diabetic Patients With High-Risk Spect Imaging Treated With Coronary Artery Bypass Grafting

Circulation ◽  
2005 ◽  
Vol 112 (9_supplement) ◽  
Author(s):  
Paul Sorajja ◽  
Panithaya Chareonthaitawee ◽  
Navin Rajagopalan ◽  
Todd D. Miller ◽  
Robert L. Frye ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
High Risk ◽  
Artery Bypass ◽  
Survival Advantage ◽  
Diabetic Patients ◽  
Bypass Grafting ◽  
Artery Disease ◽  
Bypass Angioplasty Revascularization Investigation

Background— The Bypass Angioplasty Revascularization Investigation trial demonstrated that symptomatic diabetics with multivessel coronary artery disease had a survival advantage with initial coronary artery bypass grafting (CABG) versus percutaneous coronary intervention (PCI). No published study has examined different treatments and outcome in asymptomatic diabetics. Methods and Results— This study group consisted of 826 asymptomatic diabetics (age 62±12 years; 76% men) without known coronary artery disease who had abnormal myocardial perfusion during stress single photon emission computed tomography (SPECT). SPECT images were classified as low-, intermediate-, and high-risk. Early revascularization (CABG or PCI ≤4 months after SPECT) was performed in 76 patients. Survival (follow-up, 5.3±3.3 years) was compared in patients treated with CABG, PCI, or medical therapy. Revascularization (CABG or PCI) was performed in 54 of 261 patients with high-risk scans and was independently associated with improved survival (χ 2 =4.55; P =0.03 after multivariate adjustment). Subset analysis demonstrated that the survival advantage was confined to patients treated with CABG (n =39), with a 5-year survival CABG at 85%, PCI at 72%, and medical therapy at 67% ( P =0.02 for 3 groups). Although CABG was associated with better survival, mortality remained high (3% per year). There was no survival advantage by treatment for patients with less-severe SPECT abnormalities. Conclusions— These nonrandomized data suggest that CABG improves survival in asymptomatic diabetic patients with high-risk SPECT, although revascularization was performed infrequently in these patients. These results parallel those of the Bypass Angioplasty Revascularization Investigation trial in symptomatic diabetic patients.

Drug-Eluting Stent Versus Coronary Artery Bypass Grafting for Diabetic Patients With Multivessel and/or Left Main Coronary Artery Disease: A Meta-Analysis

Angiology ◽  
2019 ◽  
Vol 70 (8) ◽  
pp. 765-773 ◽  
Author(s):  
Kongyong Cui ◽  
Shuzheng Lyu ◽  
Xiantao Song ◽  
Hong Liu ◽  
Fei Yuan ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Observational Studies ◽  
Left Main Coronary Artery ◽  
Meta Analysis ◽  
Artery Bypass ◽  
Drug Eluting Stent ◽  
Diabetic Patients ◽  
Drug Eluting ◽  
Artery Disease

With the development of stent design and surgical techniques, the relative benefit of percutaneous coronary intervention (PCI) versus coronary artery bypass grafting (CABG) in patients with diabetes and complex coronary artery disease are highly debated. This meta-analysis was conducted to compare the outcomes of drug-eluting stent (DES) implantation and CABG in these cohorts. A comprehensive search of PubMed, Embase, and Cochrane Library up to January 4, 2018, was performed. Only randomized controlled trials (RCTs), subgroup analysis from RCTs, or adjusted observational studies were eligible. Five RCTs and 13 adjusted observational studies involving 17 532 patients were included. Overall, PCI with DES was significantly associated with higher risk of all-cause mortality (hazard ratio [HR]: 1.16, 95% confidence interval [CI]: 1.05-1.29), myocardial infarction (MI; HR: 1.69, 95% CI: 1.43-2.00), and repeat revascularization (HR: 3.77, 95% CI: 2.76-5.16) compared with CABG. Nevertheless, the risk of stroke was significantly lower in the DES group (HR: 0.67, 95% CI: 0.54-0.83). The incidence of the composite end point of death, MI, or stroke was comparable between the 2 groups (HR: 0.99, 95% CI: 0.84-1.17). Despite the higher risk of stroke, CABG was better than PCI with DES for diabetic patients with multivessel and/or left main coronary artery disease.

Abstract 13346: The Rate of Incomplete Revascularization Following Coronary Artery Bypass Surgery Has Increased Over Time

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Chase R Soukup ◽  
Christian W Schmidt ◽  
Carmen Chan-Tram ◽  
Ross F Garberich ◽  
Benjamin Sun ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Coronary Artery Bypass ◽  
Coronary Artery Bypass Surgery ◽  
Bypass Surgery ◽  
Artery Bypass ◽  
Complete Revascularization ◽  
Incomplete Revascularization ◽  
Artery Disease ◽  
Over Time

Introduction: Incomplete revascularization following coronary artery bypass surgery (CABG) is associated with increased repeat revascularization, myocardial infarction and death. However, whether the rate of incomplete revascularization is increasing over time has not been previously described. Methods: We performed a retrospective review of consecutive patients who underwent elective and isolated CABG for multi-vessel coronary artery disease in 2007 (n=291) and in 2017 (n=290) at a single Institution. All coronary angiograms and CABG operative reports were reviewed and a Revascularization Index Score (RIS) was created to compare rates of incomplete revascularization between the two time periods based on the coronary anatomy and degree of stenosis. Thus a patient with complete revascularization will have an RIS score of 1.0 while a patient who has 3 of 4 eligible vessels bypassed will have an RIS score of 0.75. Results: Over a 10 year period, the rate of incomplete revascularization increased from 17.9% to 28.3% (p = 0.003) and was accompanied by a decline in the RIS score from 0.73 to 0.67 (p= 0.005). Mortality significantly increased over time with incomplete compared to complete revascularization in the 2007 cohort. Conclusions: The incidence of incomplete revascularization following CABG significantly increased over a 10-year time period between 2007 and 2017. These differences may be attributable to patient factors including more severe coronary artery disease associated with older age, greater incidence of smoking and previous PCI. In line with previous. meta-analyses, the incidence of mortality over time was higher in those patients with incomplete compared to those with complete revascularization. These results suggest that patients with incomplete revascularization represents an important target for the development of novel therapies.

scholarly journals Effect of Off-pump Coronary Artery Bypass Graft Surgery in Patients with Diabetes Mellitus

2019 ◽  
Vol 8 (1-2) ◽  
pp. 10-16
Author(s):  
Md Sharif Hasan ◽  
Abdul Hamid ◽  
Ahsan Habibur Rahman ◽  
Nurul Amin ◽  
Tanvir Ahmed ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Postoperative Outcome ◽  
Diabetic Group ◽  
Diabetic Patients ◽  
Off Pump ◽  
Artery Disease ◽  
Pump Coronary Artery Bypass

Background & objective : Myocardial revascularization in diabetic patients is challenging. Off pump coronary artery bypass (OPCAB) surgery has been widely used for the treatment of coronary artery disease. The goal of this study was to compare outcomes of OPCAB in diabetic patients relative to non diabetic patients. Methods:The present prospective study was conducted between January 2014 to June 2017. During the period a total of 193 patients (of whom 70 had diabetes and 123 patients were non-diabetics) were included in the study. All of them underwent coronary artery bypass grafting (CABG) without cardiopulmonary bypass surgery. The early clinical outcomes of OPCAB were evaluated during the postoperative hospital stay. Result: Over three-quarters of the patients in both diabetic and non-diabetic groups were ≥ 50 years old with no significant intergroup difference (p = 0.825). Majority(90%) of the patients in either group was male (p = 0.786). Nearly half (48.5%) of the patients in diabetic and 45% in non-diabetic group were overweight or obese (p = 0.557). The smokers weremuch higher in non-diabetic group than that in the diabetics (p = 0.009). The average number of grafts needed was considerably higher in the diabetic group (p = 0.079). All the postoperative outcome variables like pneumonia, stroke, arrhythmia, renal failure requiring dialysis and postoperative mortality in both the groups were almost identical (p > 0.05). Conclusion: Off-pump coronary artery bypassis the preferred choice of revascularization for multi-vessel coronary artery disease in diabetic patients. However, continuous, strict glycemic control is essential to have a good postoperative outcome. Ibrahim Card Med J 2018; 8 (1&2): 10-16

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