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01 February 2011

Endothelial function and left ventricular remodeling in diabetic and non-diabetic patients after acute coronary syndrome

Andrzej BissingerABCDEFG, Tomasz GrycewiczBCDEF, Włodzimierz GrabowiczBCD, Andrzej LubinskiAEF

DOI: 10.12659/MSM.881390

Med Sci Monit 2011; 17(2): CR73-77

Abstract

Background: Endothelial dysfunction is an independent predictor of future cardiac events.
Material/Methods: We evaluated the relationship between flow-mediated dilation (FMD) in brachial artery and coronary risk factors in 93 patients (70 males, mean age: 62±8 years) with ACS treated with primary angioplasty (PCI). The patients were divided into 2 subgroups: 43 patients with diabetes mellitus type 2 (DM) and 50 non-diabetics (non-DM). Patients were examined on the 3rd day after ACS and after 6 months. FMD on the 3rd day were significantly lower in DM than in non-DM (5.8±2.2% vs. 8.8±4.9%, p=0.0007) and after 6 months (6.2±2.6% vs. 9.4±4.4%, p<0.0001). It was also observed that the improvement of FMD in both groups after a 6-month follow-up inversely correlated with the increase of left ventricular end-diastolic volume (LVEDV) (r=–0.41, p<0.001).
Results: There was an inverse relationship between FMD and age (r=–0.26, p<0.01), BMI (r=–0.26, p<0,005), total cholesterol (r=–0.56, p<0.001) and LDL cholesterol (r=–0.53, p<0.001). There was no relationship between triglycerides, hypertension and history of smoking. In the DM group, FMD negatively correlated with HbA1c (r=–0.68, p<0.001). Restenosis rate was significantly higher in the DM group (19% vs. 6%, p<0.001) but there was no relationship between FMD and restenosis.
Conclusions: Impaired FMD is more significant in diabetics than in non-diabetic patients with ACS. Lack of improvement of FMD after acute coronary syndrome can be a predictor of detrimental left ventricular remodeling in patients with ACS.

Keywords: Endothelium, Vascular - physiopathology, Diabetes Complications - physiopathology, Demography, Coronary Vessels - physiopathology, Coronary Restenosis - physiopathology, Coronary Circulation - physiology, Angioplasty, Balloon, Coronary, Acute Coronary Syndrome - physiopathology, Vasodilation - physiology, Ventricular Remodeling - physiology

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Medical Science Monitor eISSN: 1643-3750
Medical Science Monitor eISSN: 1643-3750