Influence of Type 2 Diabetes on Functional and Structural Properties of Coronary Artery Bypass Conduits

Diabetes - Tập 52 Số 11 - Trang 2814-2820 - 2003
Roberto Lorusso1, Samuele Pentiricci1, Riccardo Raddino2, Tiziano M. Scarabelli2, Claudia Zambelli3, Vincenzo Villanacci3, A. Burattin4, Giuseppe Romanelli4, Salvatore Casari5, R Scelsi6, Andrea Giustina4
1Cardiac Surgery Division, Civic Hospital, Brescia, Italy
2Cardiology Division, Civic Hospital, Brescia, Italy
3Pathology Division, Civic Hospital, Brescia, Italy
4Internal Medicine (Endocrine Section) Division, Civic Hospital, Brescia, Italy
5Infective Disease (Statistics Unit) Division, Civic Hospital, Brescia, Italy
6Pathology Division, University of Pavia, Pavia, Italy

Tóm tắt

Recent studies have reported a high incidence of postoperative unfavorable cardiac-related events in patients with diabetes who underwent coronary artery bypass grafting (CABG). Structural and functional characteristics of CABG conduits, which have been shown to play an important role in patient outcome after myocardial revascularization, have not been fully investigated in diabetic subjects. Therefore, we sought to determine the influence of adult-onset diabetes on vasoreactivity and morphological profile of venous and arterial grafts. Of the 160 consecutive patients enrolled in the study, 90 were diagnosed with type 2 diabetes and 70 did not have diabetes (control group). All patients underwent evaluation of glucose control before surgery. Tissue specimens were collected from left internal thoracic artery (LITA) and saphenous vein (SV) grafts harvested during elective CABG. Functional tests were performed to assess contractile and vasodilative responses of bypass conduits. Histological evaluation was carried out to examine vessel wall structure. Univariate and multivariate analyses were performed to correlate the preoperative factors related to the control of the endocrine disorder with histological findings. Patient medical history and demographics did not differ between the groups. Diabetic patients showed significant microalbuminuria and higher plasma levels of C-peptide and GHb as compared with nondiabetic subjects. Functional tests of the LITA segments revealed no difference between groups with regard to contractile and vasodilative responses. In contrast, significant impairment in the endothelium-related vasodilation of the SV grafts was observed in diabetic subjects. Histological studies showed structural preservation of the arterial conduits in both groups. However, marked intimal abnormalities (also atherosclerotic calcified plaques) were detected in SV grafts harvested from diabetic patients. Logistic regression analysis showed that high levels of proteinuria and GHb were independent predictors of advanced structural degeneration of SV conduits. Treatment modality, duration of diabetes, and other demographic or metabolic factors were found to have no influence on the morphological characteristics of SV conduits. In conclusion, biological properties of LITA conduits for CABG were preserved in diabetic patients. However, these patients frequently showed impairment of the endothelium-dependent vasorelaxation and intimal degeneration of SV grafts. The extent of structural abnormalities of SV grafts was inversely correlated with the efficacy of the metabolic control of the endocrine disorder. Further studies are required to conclusively correlate preoperative SV graft abnormalities with postoperative conduit patency rate and the occurrence of adverse cardiac-related events in diabetic subjects.

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Tài liệu tham khảo

Lawrie GM, Morris GC Jr, Glaeser DH: Influence of diabetes mellitus on the results of coronary bypass surgery: follow-up of 212 diabetic patients 10 to 15 years after surgery. JAMA 256:2967–2971,1986

Morris JJ, Smith LR, Jones RH, Glower DD, Morris PB, Muhlbaier LH, Reves JG, Rankin JS: Influence of diabetes and mammary artery grafting on survival after coronary bypass. Circulation 84 (Suppl):III-275–III-284,1991

Barsness GW, Peterson ED, Ohman EM, Nelson CL, DeLong EM, Reves JG, Smith PK, Anderson RD, Jones RH, Mark DB, Califf RM: Relationship between diabetes mellitus and long-term survival after coronary bypass and angioplasty. Circulation 96:2551–2556,1997

Herlitz J, Brandup-Wongsen G, Karlsson T, Karlsson B, Haglid M, Sjoland H: Predictors of death and other cardiac events within 2 years after coronary artery bypass grafting. Cardiology 90:110–114,1998

Thourani VH, Weintraub WS, Stein B, Gebhart SS, Craver JM, Jones EL, Guyton RA: Influence of diabetes mellitus on early and late outcome after coronary artery bypass grafting. Ann Thorac Surg 67:1045–1052,1999

Whang W, Bigger JT Jr, for the CABG Patch Trial Investigators and Coordinators: Diabetes and outcomes of coronary artery bypass graft surgery in patients with severe left ventricular dysfunction: results from the CABG Patch trial database. J Am Coll Cardiol 36:1166–1172,2000

Cohen Y, Raz I, Merin G, Mozes B: Comparison of factors associated with 30-day mortality after coronary artery bypass grafting in patients with versus without diabetes mellitus. Israeli Coronary Artery Bypass (ISCAB) Study Consortium. Am J Cardiol 81:7–11,1998

Loop FD, Lytle BW, Cosgrove DM, Stewart RW, Goormastic M, Williams GW, Golding RA, Gill CC, Taylor PC, Sheldon WC: Influence of the internal mammary artery on 10-year survival and other cardiac events. N Engl J Med 314:1–6,1986

Motwani JG, Topol EJ: Aortocoronary saphenous vein graft disease: pathogenesis, predisposition and prevention. Circulation 97:916–931,1998

Hirotani T, Kameda T, Kumamoto T, Shirota S: Effects of coronary artery bypass grafting using internal mammary arteries for diabetic patients. J Am Coll Cardiol 34:532–538,1999

Stehouwer CDA, Nauta JJP, Zeldenrust GC, Hackeng WN, Donker AJ, den Ottolander GJ: Urinary albumin excretion, cardiovascular disease, and endothelial dysfunction in non-insulin dependent diabetes mellitus. Lancet 340:319–323,1992

Rodriguez-Manas L, Angulo J, Peiro C, Llergo JL, Sanches-Ferrer A, Lopez-Doriga P, Sanchez-Ferrer CF: Endothelial dysfunction and metabolic control in streptozocin-induced diabetic rats. Br J Pharmacol 123:1495–1502,1998

National Institutes of Health: Third Report of the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). Washington, DC, U.S. Govt. Printing Office,2001 (NIH publ. no. 01–3670)

Schwartz GL, Sheps SG: A review of the Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Curr Opin Cardiol 14:161–168,1999

Thiene G, Miazzi P, Valsecchi M, Valente M, Bortolotti U, Casarotto D, Gallucci V: Histological survey of the saphenous vein before its use as autologous aortocoronary bypass graft. Thorax 35:519–522,1980

Beckman JA, Creager MA, Libby P: Diabetes and atherosclerosis: epidemiology, pathophysiology, and management. JAMA 287:2570–2581,2002

Abad C, Santana C, Diaz J, Feijoo J: Arteriosclerotic histologic evaluation of the internal mammary artery in patients undergoing coronary artery bypass grafting. Eur J Cardiothorac Surg 9:198–201,1995

Sisto T, Isola J: Incidence of atherosclerosis in the internal mammary artery. Ann Thorac Surg 47:884–886,1989

Wendler O, Landwehr P, Bandner-Risch D, Georg T, Schafers HJ: Vasoreactivity of arterial grafts in the patient with diabetes mellitus: investigations on internal thoracic artery and radial artery conduits. Eur J Cardiothorac Surg 20:305–311,2001

Sellke FW, Boyle EM Jr, Verrier ED: Endothelial cell injury in cardiovascular surgery: the pathophysiology of vasomotor dysfunction. Ann Thorac Surg 62:1222–1228,1996

Soyombo AA, Angelini GD, Newby AC: Neointima formation is promoted by surgical preparation and inhibited by cyclic nucleotides in human saphenous vein organ cultures. J Thorac Cardiovasc Surg 109:2–12,1995

Quist WC, Haudenschild CC, LoGerfo FW: Qualitative microscopy of implanted vein grafts. J Thorac Cardiovasc Surg 103:671–677,1992

Karasu C, Soncul H, Altan VM: Effects of non-insulin dependent diabetes mellitus on the reactivity of human internal mammary artery and human saphenous vein. Life Sci 57:103–112,1995

Brunkwall JS, Bergquist D: Prostacyclin release from the human saphenous vein in diabetics is lower than in non-diabetics. World J Surg 16:1141–1146,1992

Umeda F, Inoguchi T, Nawata H: Reduced stimulatory activity on prostacyclin production by cultured endothelial cells in serum from aged and diabetic patients. Atherosclerosis 75:61–66,1989

Aaltomaa S, Hippelainen M, Lipponen P: Cell proliferation in aortic, mammary artery and saphenous vein biopsies in patients subjected to open heart surgery. In Vivo 11:243–247,1997

Marin ML, Veith FJ, Panetta TF, Gordon RE, Wengerter KR, Suggs WD, Sanchez E, Parides MK: Saphenous vein biopsy: a predictor of vein graft failure. J Vasc Surg 18:407–414,1993

Hicks RC, Moss J, Higman DJ, Greenhalgh RM, Powell JT: The influence of diabetes on the vasomotor responses of saphenous vein and the development of infra-inguinal vein graft stenosis. Diabetes 46:113–118,1997

Borch-Johnsen K, Kreiner S. Proteinuria: value as predictor of cardiovascular mortality in insulin-dependent diabetes mellitus. Br Med J 294:1651–1654,1987

Marso SP, Ellis SG, Tuzcu EM, Whitlow PL, Franco J, Raymond RE, Topol EJ: The importance of proteinuria as a determinant of mortality following percutaneous coronary revascularization in diabetics. J Am Coll Cardiol 33:1269–1277,1999

Uva MS, Braunberger E, Fisher M, Franco Y, Deleuze PH, Celestin JA, Bical OM: Does bilateral internal thoracic artery grafting increase surgical risk in diabetic patients?Ann Thorac Surg 66:2051–1055,1998

Giustina A, Perini P, Desenzani P, Bossoni S, Ianniello P, Dilani M, Davi G, Romanelli G: Long-term treatment with the dual antithromboxane agent picotamide decreases microalbuminuria in normotensive type 2 diabetics patients. Diabetes 47:423–430,1998

Hoogwerf BJ, Waness A, Cressman M, Canner J, Campeau L, Domanski M, Geller N, Herd A, Hickey A, Hunninghake DB, Knatterud GL, White C: Effects of aggressive cholesterol lowering and low-dose anticoagulation on clinical and angiographic outcomes in patients with diabetes: the Post CABG Trial. Diabetes 48:1289–1294,1999

Romanelli G, Giustina A, Cimino A, Valentini U, Agabiti-Rosei E, Muiesan G, Giustina G: Short-term effect of captopril on microalbuminuria induced by exercise in normotensive diabetics. Br Med J 298:284–288,1989

Romanelli G. Giustina A, Bossoni S, Caldonazzo A, Cimino A, Cravarezza P, Giustina G: Short-term administration of captopril and nifedipine and exercise-induced albuminuria in normotensive diabetic patients with early stage nephropathy. Diabetes 39:1333–1338,1990

Giustina A, Bossoni S, Cimino A, Comini MT, Gazzoli N, Leproux GB, Wehrenberg WB, Giustina G: Picotamide: a dual TXB synthatase inhibitor and TXB receptor antagonist, reduces exercise-induced albuminuria in microalbuminuric patients with NIDDM. Diabetes 42:178–182,1993

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Diabetes

Tập 52 Số 11

2814-2820

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