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CMR in the evaluation of the results of percutaneous coronary interventions in patients with diabetes mellitus type 2 and chronic heart failure
D A Maximkin2
1Azerbaijan Medical University, Internal Medicine - Baku - Azerbaijan
2RUDN University - Moscow - Russian Federation
Aim: to evaluate the effectiveness of PCI in patients with multivessel coronary disease and concomitant diabetes and chronic heart failure.
Methods: 102 patients were divided into 2 groups: group 1 (n=48) - patients with diabetes, and group 2 (n=54) - patients with coronary artery disease and heart failure without diabetes. Inclusion criteria: myocardial infarction in previously; angina II-III (CCS); silent ischemia; multivessel disease (SYNTAX score I <32); segments with abnormality local kinetic of the left ventricle; chronic heart failure I-III (NYHA); left ventricular ejection fraction (LVEF) is less than 45%. Visualization of post-infarction myocardial changes was performed using CMR, both before PCI and during the evaluation of long-term results. Primary endpoints: MACE (death, MI, repeated interventions).
Results: after 24 months, MACE in groups 1 and 2 was 10.4 and 8.1%, respectively (p=0.264). After PCI, in both groups there was a significant decrease a number of segments with abnormality local kinetic, compared with baseline data (p<0.05). In patients with diabetes, as well as in patients without diabetes, there is a significant increase in LVEF by as early as 12 months after PCI, as well as a decrease in end-diasystolic volume (EDV) and end-diasystolic size (EDS) of the left ventricle. A similar steady trend continues to 24 months of observation. The average data of the transmurality index in group 1 decreased, as compared with the pre-operative values, from 0.39±0.07 to 0.32±0.02. The average difference was 0.07 [0.02-0.08; 95% CI, p = 0.01]. In patients with diabetes, the number of pathological segments in the zone of hibernated myocardium directly correlates with the index of transmurality. The lower the transmurality index, the smaller the number of pathological segments detected and the better the recovery processes of dysfunctional myocardium occur. Unlike the index of trasmurality, the index of cardiac fibrosis does not correlate with the number of pathological segments in the hibernation zone. Factors associated with the development of MACE in patients with diabetes: HbA1c =6.5% to PCI, fasting plasma glucose =6.0 mmol / l, total cholesterol =5.2 mmol / l, triglycerides =1.7 mmol / l, LDL cholesterol =2.5 mmol / l. In addition, performing PCI after 30 days from myocardial infarction, as well as incomplete myocardial revascularization, SYNTAX score> 25, transmural index =0.45, cardiac fibrosis volume =45%, were also unfavorable risk factors for the development of MACE. At the same time, reduced LVEF was not a predictor of an unfavorable prognosis of PCI in such patients.
Conclusion: the frequency of MACE, as well as the dynamics of recovery of hibernated myocardium function, in patients with diabetes and chronic heart failure, is comparable to that in patients without diabetes mellitus. At the same time, the smaller the value of the transmurality index, the better the recovery processes of dysfunctional myocardium occur.
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