Effects of myocardial revascularization on diastolic function andleft ventricular myocardial strain in the early period after coronaryartery bypass grafting in patients with coronary heart disease anstype 2 diabetes mellitus

Authors: A.Z. Mustafaeva, T.V. Zavalikhina, N.I. Bulaeva, M.V. Grigoryan, S.N. Kazanovskaya, E.Z. Golukhova

Company: A.N. Bakoulev Scientific Center for Cardiovascular Surgery; Rublevskoe shosse, 135, Moscow, 121552, Russian Federation


Keywords: diastolic function strain diabetes mellitus type 2 coronary artery disease coronary artery bypass grafting

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Abstract

Objective. To investigate impact of myocardial revascularization by coronary bypass surgery on diastolic function and left ventricle myocardial deformation in patients with stable coronary artery disease and diabetes mellitus type 2 during early postoperative period.
Material and methods. 40 patients with stable coronary artery disease took part in the study. The patients were divided into 2 groups. Group 1 included 20 patients without diabetes mellitus, 50% of them experienced myocardial infarction. Group 2 included 20 patients with diabetes mellitus type 2; 50% of them experienced myocardial infarction. Average age of the patients in this study was 57.2±8.6 years. All patients had undergone global and segmental evaluation of systolic and diastolic left ventricle myocardial function prior coronary bypass surgery and during early postoperative period. A glycemic control and an analysis of its impact on changeable indexes were also evaluated.
Results. Diastolic left ventricle myocardial dysfunction was detected in 65% with stable IHD and in 85% of patients with IHD and with metabolic disorder. The most spread type of left ventricle diastolic dysfunction was slow relaxation (type 1) – 60% of cases without diabetes and in 80% of cases with diabetes mellitus type 2. Deformation and deformation speed is slowed down in both patients groups in all segments (р<0.05); especially in basal segment (р<0.01) and is in direct interrelation with affected coronary arteries localization. An improvement of deformation index and deformation speed in all segments of revasculated myocardium was detected in both patients with and without diabetes mellitus during early postoperative period.
Conclusion. The defects of segmentary systolic and diastolic left ventricle myocardium function in patients with stable coronary artery disease are partially inversive after coronary revascularization by coronary bypass grafting. Moreover, negative impact of diabetes mellitus type 2 on deformation indexes in early postoperative period after coronary bypass grafting was not revealed.

References

1. IDF Diabetes Atlas Update; 2012. Available at: http://www.idf.org/diabetesatlas/5e/Update2012.

2. Соколов Е.И., Заев А.П., Ольха Р.П. и др. Пора- жения миокарда при сахарном диабете по дан- ным эхокардиографии. Пробл. эндокринол. 1996; 2: 15–7.

3. Хамуев Я.П. Диастолическая дисфункция левого желудочка и прогноз у больных ишемической болезнью сердца с сердечной недостаточнос- тью. Креативная кардиология. 2010; 2: 71–80.

4. Какучая Т.Т. Тканевой допплер, деформация и скорость деформации миокарда в оценке функ- ции миокарда – концептуальные технические основы и применение в клинике. Креативная кардиология. 2008; 1: 73–93.

5. Nakai H., Takeuchi M., Nishikage T., Lang R.M., Otsuji Y. Subclinical left ventricular dysfunction in asymptomatic diabetic patients assessed by two- dimensional speckle tracking echocardiography: correlation with diabetic duration. Eur. J. Echocardiogr. 2009; 10 (8): 926–32.

6. Zoroufian A., Razmi T., Taghavi-Shavazi M., Lotfi- Tokaldany M., Jalali A. Evaluation of subclinical left ventricular dysfunction in diabetic patients: Longitudinal strain velocities and left ventricular dyssynchrony by two-dimensional speckle tracking echocardiography study. Echocardiography. 2014; 31 (4): 456–63.

7. Королева Т.В., Георгадзе З.О., Васильева А.Е., Варгина Т.С., Фомина И.Г. Диастолическая дис- функция миокарда у больных ишемической бо- лезнью сердца и сахарным диабетом 2 типа. Кардиоваскулярная терапия и профилактика. 2004; 3 (5): 65–8.

8. Herlitz J., Wognses G.B., Emanuelsson H. et al. Mortality and morbidity in diabetic and nondiabetic patients during a two-year period after coronary artery bypass grafting. Diabetes Care. 1996; 19: 698–703.

9. Morris J.J., Smith R., Jones R.H. et al. Influence of diabetes and mammary artery grafting on survival after coronary bypass. Circulation. 1991; 84, Suppl. 3: III-275–84.

10. Thourani V.H., Weintraub W.S., Stein B. et al. Influence of diabetes mellitus on early and late outcome after coronary artery bypass grafting. Ann. Thorac. Surg. 1999; 67: 1045–52.

11. Lawrie G.M., Morris G.C., Glaeser D.H. Influence of diabetes mellitus on the results of coronary bypass surgery. JAMA. 1986; 256: 2967–71.

12. Smith R.L., Harrell F.E., Rankin J.S. et al. Determinants of early versus late cardiac death in patients undergoing coronary artery bypass graft surgery. Circulation. 1991; 84, Suppl. 3: III-245–53.

13. Adler D.S., Goldman L., O'Neil A. et al. Long-term survival of more than 2,000 patients after coronary artery bypass grafting. Am. J. Cardiol. 1986; 58: 195–202.

14. Бокерия О.Л., Биниашвили М.Б. Внезапная сер- дечная смерть и ишемическая болезнь сердца. Анналы аритмологии. 2013; 10 (2): 69–79. DOI: 10.15275/annaritmol.2013.2.2.

15. Whang W., Bigger J.T., Jr. 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. 2000; 4: 1166–72.

16. Kowalski M., Kukulski T., Jamal F., D`hooge J., Weidemann F., Rademakers F. et al. Can natural strain and strain rate quantify regional myocardial deformation? A study in healthy subjects. Ultrasound Med. Biol. 2001; 27: 1087–97.

17. Какителашвили М.А. Диагностические особен- ности и оценка ближайших результатов опера- ций реваскуляризаций миокарда у больных ИБС в сочетании с сахарным диабетом: дис. ... канд. мед. наук. М.; 2004: 121.

18. Трельская Н.Ю., Сарапульцев П.А. Диастоличес- кая функция сердца у больных сахарным диабе- том 2 типа. Медицинская наука и практика. 2004; 7: 24–8.

19. Никоненко А.С., Молодан А.В., Осауленко В.В., Олешко С.В., Наконечный С.Ю., Иващук В.А. Оценка сегментарной деформации миокарда ЛЖ у пациентов с ИБС после реваскуляриза- ции миокарда в раннем послеоперационном периоде. Ежегодник научных трудов ассоциа- ции сердечно-сосудистых хирургов Украины ≪Сердечно-сосудистая хирургия≫. Киев; 2013. Выпуск 21: 333–8.

20. Youn Y.-N., Shim C.Y., Yang H., Hong S., Chung N., Yoo K.-J. Effect of diastolic dysfunction on early outcomes during elective off-pump coronary artery bypass grafting: A prospective observational study. Ann. Thorac. Surg. 2011; 92: 587–94.

Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, President of Bakoulev National Medical Research Center for Cardiovascular Surgery