Severely impaired microvascular reactivity in diabetic patients with an acute coronary syndrome

There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

Abstract

Background

Microvascular function is impaired in patients with stable coronary artery disease. The aim was to study microvascular function in patients with diabetes and acute coronary syndrome (ACS).

Methods

Microvascular function was evaluated in 83 patients by laser Doppler fluxmetry (LDF) [PU; perfusion unit, median (interquartile range)] measuring resting LDF and peak LDF following a six min heating of the skin to 44 °C at the foot, respectively. All patients with ACS and without previously known diabetes underwent oral glucose tolerance test. Thirty-nine patients with type 2 diabetes mellitus free from coronary artery disease served as controls.

Results

Peak LDF was significantly (P = 0.03) lower in patients with ACS and diabetes (n = 22; 72 (52)) and diabetes without coronary artery disease (n = 39; 69 (51)) as compared to patients with ACS without diabetes (n = 46; 97 (60)), and patients without ACS (n = 15; 140 (121)), respectively. Patients with ACS (n = 68) had significantly (P = 0.04) lower peak LDF (92 (49)) as compared to patients without ACS (n = 15) (140 (121)).

Conclusion

Microvascular reactivity is severely impaired in patients with diabetes and ACS. Diabetes has a major influence on microvascular function in patients with coronary artery disease.

Related collections

Most cited references 33

Record: found
Abstract: found
Article: not found

Long-term follow-up of patients with mild coronary artery disease and endothelial dysfunction.

J Suwaidi, S Hamasaki, S T Higano … (2000)

Coronary endothelial dysfunction is characterized by vasoconstrictive response to the endothelium-dependent vasodilator acetylcholine. Although endothelial dysfunction is considered an early phase of coronary atherosclerosis, there is a paucity of information regarding the outcome of these patients. Thus, this study was designed to evaluate the outcome of patients with mild coronary artery disease on the basis of their endothelial function. Follow-up was obtained in 157 patients with mildly diseased coronary arteries who had undergone coronary vascular reactivity evaluation by graded administration of intracoronary acetylcholine, adenosine, and nitroglycerin and intracoronary ultrasound at the time of diagnostic study. Patients were divided on the basis of their response to acetylcholine into 3 groups: group 1 (n=83), patients with normal endothelial function; group 2 (n=32), patients with mild endothelial dysfunction; and group 3 (n=42), patients with severe endothelial dysfunction. Over an average 28-month follow-up (range, 11 to 52 months), none of the patients from group 1 or 2 had cardiac events. However, 6 (14%) with severe endothelial dysfunction had 10 cardiac events (P<0.05 versus groups 1 and 2). Cardiac events included myocardial infarction, percutaneous or surgical coronary revascularization, and/or cardiac death. Severe endothelial dysfunction in the absence of obstructive coronary artery disease is associated with increased cardiac events. This study supports the concept that coronary endothelial dysfunction may play a role in the progression of coronary atherosclerosis.

0 comments Cited 300 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

Glucose metabolism in patients with acute myocardial infarction and no previous diagnosis of diabetes mellitus: a prospective study.

Anna Norhammar, Ake Tenerz, Göran Nilsson … (2002)

Glycometabolic state at hospital admission is an important risk marker for long-term mortality in patients with acute myocardial infarction, whether or not they have known diabetes mellitus. Our aim was to ascertain the prevalence of impaired glucose metabolism in patients without diagnosed diabetes but with myocardial infarction, and to assess whether such abnormalities can be identified in the early course of a myocardial infarction. We did a prospective study, in which we enrolled 181 consecutive patients admitted to the coronary care units of two hospitals in Sweden with acute myocardial infarction, no diagnosis of diabetes, and a blood glucose concentration of less than 11.1 mmol/L. We recorded glucose concentrations during the hospital stay, and did standardised oral glucose tolerance tests with 75 g of glucose at discharge and again 3 months later. The mean age of our cohort was 63.5 years (SD 9) and the mean blood glucose concentration at admission was 6.5 mmol/L (1.4). The mean 2-h postload blood glucose concentration was 9.2 mmol/L (2.9) at hospital discharge, and 9.0 mmol/L (3.0) 3 months later. 58 of 164 (35%, 95% CI 28-43) and 58 of 144 (40%, 32-48) individuals had impaired glucose tolerance at discharge and after 3 months, respectively, and 51 of 164 (31%, 24-38) and 36 of 144 (25%, 18-32) had previously undiagnosed diabetes mellitus. Independent predictors of abnormal glucose tolerance at 3 months were concentrations of HbA(1c) at admission (p=0.024) and fasting blood glucose concentrations on day 4 (p=0.044). Previously undiagnosed diabetes and impaired glucose tolerance are common in patients with an acute myocardial infarction. These abnormalities can be detected early in the postinfarction period. Our results suggest that fasting and postchallenge hyperglycaemia in the early phase of an acute myocardial infarction could be used as early markers of high-risk individuals.

0 comments Cited 166 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

Individuals at increased coronary heart disease risk are characterized by an impaired microvascular function in skin.

Hilde de Boeck, Erik Serné, Marella F. T. R. de Bruijn … (2003)

To investigate whether microvascular function in skin is a valid model to study the relationships between cardiovascular risk factors and microvascular function, we investigated skin microvascular function in individuals with increased coronary heart disease (CHD) risk. Forty-six healthy White individuals aged 30-70 years were studied. Coronary heart disease risk was assessed with the use of the CHD risk score according to the Framingham Heart Study, which is based on the risk factors age, blood pressure, cigarette smoking, total cholesterol, HDL cholesterol and diabetes. Endothelium-dependent and -independent vasodilation in skin were evaluated with laser Doppler after iontophoresis of acetylcholine and sodium nitroprusside. Videomicroscopy was used to measure recruitment of skin capillaries after arterial occlusion. Coronary heart disease risk score (i.e. the 10-year probability of CHD) varied from 1-37%. Microvascular function decreased with increasing quartiles of CHD risk (for acetylcholine-mediated vasodilation: 687, 585, 420 and 326%, P = 0.002; for nitroprusside-mediated vasodilation: 776, 582, 513 and 366%, P = 0.02; for capillary recruitment: 49.9, 44.6, 27.2 and 26.7%, P = 0.001). These trends were similar in men and women (P for interaction > 0.2) and independent of body mass index. Increased CHD risk is associated with an impaired endothelium-dependent vasodilatation and capillary recruitment in skin, suggesting that microvascular function in skin is a valid model to study the relationships between cardiovascular risk factors and microvascular function.

0 comments Cited 58 times – based on 0 reviews      Review now

Bookmark

All references

Author and article information

Contributors

Nikolaos Östlund Papadogeorgos:

ORCID: http://orcid.org/0000-0003-0960-3281

+46 8 6557993 , nikolaos.ostlund-papadogeorgos@ds.se

Gun Jörneskog: gun.jorneskog@ds.se

Mattias Bengtsson: mattias.bengtsson@ds.se

Thomas Kahan: thomas.kahan@ds.se

Majid Kalani: drmkalani@gmail.com

Journal

Journal ID (nlm-ta): Cardiovasc Diabetol

Journal ID (iso-abbrev): Cardiovasc Diabetol

Title: Cardiovascular Diabetology

Publisher: BioMed Central (London )

ISSN (Electronic): 1475-2840

Publication date (Electronic): 20 April 2016

Publication date PMC-release: 20 April 2016

Publication date Collection: 2016

Volume: 15

Electronic Location Identifier: 66

Affiliations

[ ]Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden

[ ]Dept of Cardiology, Danderyd University Hospital Corp, 182 88 Stockholm, Sweden

Author information

Nikolaos Östlund Papadogeorgos http://orcid.org/0000-0003-0960-3281

Article

Publisher ID: 385

DOI: 10.1186/s12933-016-0385-6

PMC ID: 4837627

PubMed ID: 27095564

SO-VID: 2585a6bc-aed1-4594-9a54-5da45211ba67

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 4 February 2016

Date accepted : 7 April 2016

Funding

Funded by: Karolinska Institutet (SE)

Custom metadata

ScienceOpen disciplines: Endocrinology & Diabetes

Keywords: microvascular reactivity,coronary artery disease,acute coronary syndrome,diabetes mellitus,laser doppler fluxmetry

Data availability:

ScienceOpen disciplines: Endocrinology & Diabetes

Keywords: microvascular reactivity, coronary artery disease, acute coronary syndrome, diabetes mellitus, laser doppler fluxmetry

Severely impaired microvascular reactivity in diabetic patients with an acute coronary syndrome

Read this article at

Abstract

Background

Methods

Results

Conclusion

Related collections

Cardiovascular Innovations and Applications

Most cited references 33

Long-term follow-up of patients with mild coronary artery disease and endothelial dysfunction.

Glucose metabolism in patients with acute myocardial infarction and no previous diagnosis of diabetes mellitus: a prospective study.

Individuals at increased coronary heart disease risk are characterized by an impaired microvascular function in skin.

Author and article information

Contributors

Journal

Affiliations

Author information

Article

History

Funding

Categories

Custom metadata

Comments

Comment on this article

Similar content 538

Cited by 9

Most referenced authors 596