D. Molotiagin, O. Kadikova, P. Kravchun
Kharkiv National Medical University
Introduction. Coronary artery disease (CAD) is one of the leading causes of disability and mortality of the population. Diabetes mellitus (DM) is one of the significant risk factors for patients with CAD. There is a need to detect early signs of these diseases and improve the quality of diagnosis of coronary damage. One of the pathogenetic mechanisms of atherosclerosis is generalized or chronic inflammation. First of all, the problem of the inflammatory component role in the pathogenesis of atherosclerosis in patients with DM type 2 is studied. One of the new perspective markers of immune inflammation is pentraxin-3 (PTX-3), but its role in the pathogenesis of atherosclerosis has not been finally found out.
The aim of the study. To evaluate the features of cardiohemodynamics and injury of coronary arteries in patients with coronary artery disease with type 2 diabetes mellitus depending on the activity of immune inflammation based on the study of indicators of serum pentraxin-3.
Materials and methods. A comprehensive examination of 110 patients with CAD was performed (women – 56, men – 54; the average age of women was 64.34 ± 2.31 years, the average age of men was 61.78 ± 3.12 years). Patients were divided into groups depending on the presence of DM type 2. The first group included 75 patients with stable CAD and DM type 2 (experimental group: women – 39, men – 36, aged 64.42 ± 2.39 and 61.89 ± 3.17 years respectively), the comparison group consisted of 35 patients with CAD without DM: women – 17, men – 18, age 64.17 ± 2.57 and 61.65 ± 3.27 years respectively). Measurements of cardiohemodynamics, general clinical and instrumental examinations (Doppler echocardiography and coronary ventriculography) were made to all patients.
Results. The cardiohemodynamics status in patients with CAD with comorbid DM type 2 depended on the content of PTX-3. In the subgroup of patients with CAD and DM type 2 with a PTX-3 level more than 5.03 ng/ml, significantly higher values of end-diastolic volume (EDV), еnd-systolic volume (ESV), end-diastolic diameter (EDD), end-systolic diameter (ESD) and lower value of ejection fraction (EF) were observed. The EDV in patients of the first subgroup was 107.71 ± 9.13 ml, which is 23.77 % lower than in patients of the second subgroup, where the value of this indicator was 141.29 ± 8.40 ml (p < 0.05). ESV was 19.83 % higher in patients of the second subgroup (61.32 ± 7.10 ml vs. 49.16 ± 6.40 ml) (p < 0.05), EDD – 24,39 %, ESD – 23,01 %, and EF, on the contrary, is 17.95 % lower in patients of the second subgroup (44.81 ± 6.28 % vs. 54.61 ± 6.17 %) (р < 0.05). The features of the coronary artery damage also was estimated. Damage of the left main coronary artery was detected more often in patients of the second subgroup than in patients of the first subgroup. Thus, we established that for conditions of immune inflammation activation in patients with CAD and DM type 2, the structural restructuring of the heart due to the increase in the size and cavities of the left ventricle occurs reducing the ability of the myocardium to contract. In patients with CAD and DM type 2, activation of immune inflammation is associated with the damage of the left main coronary artery.
Conclusions. Structural and functional state of the myocardium is worsen in patients with and concomitant type 2 diabetes mellitus due to the negative effect of system inflammation activation against the background of increasing levels of pentraxin-3. The association between pentraxin-3 level and left coronary artery damage in patients with coronary artery disease with type 2 diabetes mellitus is established – it is a direct strong correlation (r = 0.83; р <0.05).
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