scholarly journals Reduced coronary collateralization in type 2 diabetic patients with chronic total occlusion

2018 ◽  
Vol 17 (1) ◽  
Author(s):  
Ying Shen ◽  
Feng Hua Ding ◽  
Yang Dai ◽  
Xiao Qun Wang ◽  
Rui Yan Zhang ◽  
...  
Keyword(s):  
Chronic Total Occlusion ◽  
Diabetic Patients ◽  
Type 2 Diabetic Patients ◽  
Total Occlusion ◽  
Type 2 Diabetic

scholarly journals Impact of coronary collateralization on long-term clinical outcomes in type 2 diabetic patients after successful recanalization of chronic total occlusion

2020 ◽  
Author(s):  
Zhen Kun Yang ◽  
Ying Shen ◽  
Yang Dai ◽  
Xiao Qun Wang ◽  
Jian Hu ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Chronic Total Occlusion ◽  
Left Ventricular ◽  
Diabetic Patients ◽  
Type 2 Diabetic Patients ◽  
Total Occlusion ◽  
Repeat Revascularization ◽  
Type 2 Diabetic

Abstract Background: To assess the prognostic role of coronary collaterals in patients with type 2 diabetes mellitus (T2DM) after successful percutaneous coronary intervention (PCI) for chronic total occlusion (CTO). Methods: Coronary collateralization was graded according to Rentrop scoring system in 198 type 2 diabetic patients and 335 non-diabetics with stable angina undergoing PCI for at least one CTO lesion. Left ventricular ejection fraction (LVEF) was determined and major adverse cardio-cerebral events (MACCE) were recorded during follow-up. Results: Poor collateralization was more common in patients with T2DM than in non-diabetics (40% vs 29%, p=0.008). At 13.5±4.1 months, the rate of composite MACCE (17.3% vs 27.6%, p=0.034) and repeat revascularization (15.2% vs 25.5%, p=0.026) was lower and the increase in LVEF (3.10 % vs 1.80%, p=0.024) was greater in patients with good collaterals than in those with poor collaterals for non-diabetic group, but did not differ for T2DM group (35% vs 44%; 30% vs 36%; 2.14% vs 1.65%, respectively, all p>0.05) except for a higher all-cause mortality in diabetic patients with poor collaterals (p=0.034). Multivariable Cox proportional hazards analysis showed that coronary collateralization was an independent factor for time to MACCE (HR 2.155，95%CI 1.290-3.599, P=0.003) and repeat revascularization (HR 2.326, 95%CI 1.357-3.986, p=0.002) in non-diabetic patients, but did not enter the model in those with T2DM. Conclusions: T2DM is associated with reduced coronary collateralization. Successful revascularization of CTO lesions results in a mild improvement in left ventricular function, but t he status of coronary collaterals has no independent effect on long-term clinical outcomes in patients with T2DM.

scholarly journals Impact of coronary collateralization on long-term clinical outcomes in type 2 diabetic patients after successful recanalization of chronic total occlusion

2020 ◽  
Author(s):  
Zhen Kun Yang ◽  
Ying Shen ◽  
Yang Dai ◽  
Xiao Qun Wang ◽  
Jian Hu ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Chronic Total Occlusion ◽  
Left Ventricular ◽  
Diabetic Patients ◽  
Type 2 Diabetic Patients ◽  
Total Occlusion ◽  
Repeat Revascularization ◽  
Type 2 Diabetic

Abstract Background: To assess the prognostic role of coronary collaterals in patients with type 2 diabetes mellitus (T2DM) after successful percutaneous coronary intervention (PCI) for chronic total occlusion (CTO).Methods: Coronary collateralization was graded according to Rentrop scoring system in 198 type 2 diabetic patients and 335 non-diabetics with stable angina undergoing PCI for at least one CTO lesion. Left ventricular ejection fraction (LVEF) was determined and major adverse cardio-cerebral events (MACCE) were recorded during follow-up.Results: Poor collateralization was more common in patients with T2DM than in non-diabetics (40% vs 29%, p=0.008). At 13.5±4.1 months, the rate of composite MACCE (17.3% vs 27.6%, p=0.034) and repeat revascularization (15.2% vs 25.5%, p=0.026) was lower and the increase in LVEF (3.10 % vs 1.80%, p=0.024) was greater in patients with good collaterals than in those with poor collaterals for non-diabetic group. The associations were in the same direction for T2DM group (35% vs 44%; 30% vs 36%; 2.14% vs 1.65%, respectively) with a higher all-cause mortality in diabetic patients with poor collaterals (p=0.034). Multivariable Cox proportional hazards analysis showed that coronary collateralization was an independent factor for time to MACCE (HR 2.155，95%CI 1.290-3.599, P=0.003) and repeat revascularization (HR 2.326, 95%CI 1.357-3.986, p=0.002) in non-diabetic patients, but did not enter the model in those with T2DM.Conclusions: T2DM is associated with reduced coronary collateralization. The effects of the status of coronary collateralization on long-term clinical outcomes and left ventricular function appear to be similar in size in type 2 diabetic patients and non-diabetics after successful recanalization of CTO.

scholarly journals High serum levels of CML are associated with poor coronary collateralization in type 2 diabetic patients with chronic total occlusion of coronary artery

2022 ◽  
Author(s):  
Le Ying Li ◽  
Ying Shen ◽  
Shuai Chen ◽  
Fei Fei Li ◽  
Zhi Ming Wu ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Roc Curve ◽  
Chronic Total Occlusion ◽  
Serum Levels ◽  
High Serum ◽  
Diabetic Patients ◽  
Type 2 Diabetic Patients ◽  
Total Occlusion

Abstract Background: The formation of advanced glycation end-products (AGEs) is a crucial risk factor for the pathogenesis of cardiovascular diseases. We investigated whether N-e-carboxy-methyl-lysine (CML), a major form of AGEs in vivo, was associated with poor coronary collateral vessel (CCV) formation in patients with type 2 diabetes mellitus (T2DM) and chronic total occlusion (CTO) of coronary artery.Methods: This study consisted of 242 T2DM patients with angiographically documented CTO. Blood samples were obtained and demographic/clinical characteristics were documented. The collateralization of these patients was defined according to Rentrop score. Receiver operating characteristic (ROC) curve and multivariable regression analysis were performed.Results: 242 patients were categorized into poor CCV group (Rentrop score 0 and 1)(n = 107) and good CCV group (Rentrop score 2 and 3)(n = 135). Serum CML levels were significantly higher in poor CCV group (110.0 ± 83.35 ng/ml) than in good CCV group (62.95 ± 58.83 ng/ml, P<0.001). Moreover, these CML levels were also significantly different across the Rentrop score 0, 1, 2 and 3 groups (P <0.001). In ROC curve for ascertaining poor CCV, AUCs were 0.70 (95% CI 0.64-0.77) for CML. In multivariable logistic regression, CML levels (P<0.001) remained independent determinants of poor CCV after adjustment of traditional risk factors. Conclusions: This study suggests that higher CML levels are associated to poor CCV in T2DM patients with CTO. Inhibition of AGEs including CML is a strategy in antagonizing poor CCV in diabetic patients.

Vitamin D3 supplementation improves glycemic control in type 2 diabetic patients: Results from an Italian clinical trial

2020 ◽  
pp. 1-10
Author(s):  
Giuseppe Derosa ◽  
Angela D’Angelo ◽  
Chiara Martinotti ◽  
Maria Chiara Valentino ◽  
Sergio Di Matteo ◽  
...  
Keyword(s):  
Vitamin D ◽  
Vitamin D Deficiency ◽  
Metabolic Control ◽  
Vitamin D3 ◽  
Therapy Group ◽  
Hypoglycemic Agents ◽  
Diabetic Patients ◽  
Type 2 Diabetic Patients ◽  
Type 2 Diabetic

Abstract. Background: to evaluate the effects of Vitamin D3 on glyco-metabolic control in type 2 diabetic patients with Vitamin D deficiency. Methods: one hundred and seventeen patients were randomized to placebo and 122 patients to Vitamin D3. We evaluated anthropometric parameters, glyco-metabolic control, and parathormone (PTH) value at baseline, after 3, and 6 months. Results: a significant reduction of fasting, and post-prandial glucose was recorded in Vitamin D3 group after 6 months. A significant HbA1c decrease was observed in Vitamin D3 (from 7.6% or 60 mmol/mol to 7.1% or 54 mmol) at 6 months compared to baseline, and to placebo (p < 0.05 for both). At the end of the study period, we noticed a change in the amount in doses of oral or subcutaneous hypoglycemic agents and insulin, respectively. The use of metformin, acarbose, and pioglitazone was significantly lower (p = 0.037, p = 0.048, and p = 0.042, respectively) than at the beginning of the study in the Vitamin D3 therapy group. The units of Lispro, Aspart, and Glargine insulin were lower in the Vitamin D3 group at the end of the study (p = 0.031, p = 0.037, and p = 0.035, respectively) than in the placebo group. Conclusions: in type 2 diabetic patients with Vitamin D deficiency, the restoration of value in the Vitamin D standard has led not only to an improvement in the glyco-metabolic compensation, but also to a reduced posology of some oral hypoglycemic agents and some types of insulin used.

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