EFFICACY OF ENDOVASCULAR CORONARY REVASCULARIZATION IN PATIENTS WITH CHD WITH REDUCED LEFT VENTRICULAR

The purpose: evaluation of long-term efficacy of endovascular coronary revascularization in patients with ischemic heart disease comorbid with type 2 diabetes mellitus and burdened with chronic heart failure with reduced left ventricular ejection fraction (LVEF) according to a 5-year prospective study.

Materials and Methods: the study involved 53 patients with ischemic heart disease with left ventricular ejection fraction of 38.0% [32.0; 43.3]. In the 1st group (n = 23) consisted of patients with coronary artery disease and with reduced left ventricular ejection fraction, and in the 2nd group of 30 patients with coronary heart disease associated with type 2 diabetes mellitus and low LVEF. We analyzed the clinical, metabolic, angiologic indicators: recurrent angina, basal and postprandial glucose, glycated hemoglobin, lipid profile, echocardiography, estimated rates of adverse cardiovascular events, the survival rate.

Results: it was shown that the presence of concomitant type 2 diabetes mellitus aggravates the long-term prognosis in patients with coronary artery disease and heart failure with reduced left ventricular ejection fraction undergone stenting of coronary arteries due to progression of heart failure, leading to an increase in functional class chronic heart failure and increase the numbers of adverse cardiovascular. The forerunners of adverse cardiovascular are smoking (OR = 3.871, p = 0.01) and postprandial glucose levels (OR, 2.681; p = 0.01) and risk factors for adverse cardiovascular proved to be the lack of adequate glycemic control (NbA1S levels> 7%; χ2- 5,625, p = 0.018, and the presence of hypoglycemic episodes χ2-4,951-6,419, p = 0,04-0,004). At all stages of the following up of the patients after myocardial revascularization procedures required to implement more aggressive lipid corrective therapy to achieve target LDL cholesterol level.

Conclusion: it was proved that in patients with coronary heart disease associated with heart failure with reduced left ventricular ejection fraction and type 2 diabetes there is high efficiency of endovascular coronary revascularization providing comparable with similar patients without diabetes mellitus 5-year survival rates - 78.3 and 86.6%.

1. National guidelines PRAs, RKO and RNMOT for diagnosis and treatment of chronic heart failure (fourth revision). Prepared: Mareev V.Ju., Ageev F.T., Arutjunov G.P. et al. Serdechnaja nedostatochnost’. 2013; T. 14, 7 (81): 379-472.

2. Kaljuzhin V.V., Kaljuzhin O.V., Tepljakov A.T., Karaulov A.V. Hronicheskaja serdechnaja nedostatochnost’: voprosy jetiologii, jepidemiologii, patogeneza (gemodinamicheskie, nejrogumoral’nye, immunnye, geneticheskie aspekty), diagnostiki i lechenija: uchebnoe posobie. M.: OOO «Medic. Inform. Agenstvo»; 2006; 288 s.

3. Kannel W.B., Hjortland M., Castelli W.P. Role of diabetes in congestive heart failure: The Framingham study. Am J Cardiol. 1974; 34: 29-34.

4. Dedov I.I., Shestakova M.V., Vikulova O.K. National register of diabetes mellitus in Russian Federation: status on 2014. Saharnyj diabet. 2015; 18 (3): 5–23. doi: 10.14341/DM201535-22.

5. Seferovic P. M., Paulus W. J. Clinical diabetic cardiomyopathy: a two-faced disease with restrictive and dilated phenotypes. Eur Heart J. 2015; 36: 1718- 1727. doi: 10.1093/eurheartj/ehv134.

6. Campbell P., Krim S., Ventura H. The Bi-Directional Impact Of Two Chronic Illnesses: Heart Failure And Diabetes - A Review Of The Epidemiology And Outcomes. Cardiac Failure Review. 2015; 1 (1): 8-10. doi: 10.15420 /cfr.2015.01.01.8.

7. MacDonald M. R., Petrie M. C., Hawkins N. M. et al. Diabetes, left ventricular systolic dysfunction, and chronic heart failure. Eur Heart J. 2008; 29: 1224-1240. doi: 10.1093/eurheartj/ehn156

8. Heart disease for Braunwald: a guide to cardiovascular medicine. Ed. Libby P. et al., under the general editorship of Oganov R.G. 3rd ed.: Chapters 38-60. M.: Logosfera, 2013; 728 p.

9. Intervencionnye metody lechenija ishemicheskoj bolezni serdca: [Sb. st.]. Pod red. Bokerija L.A. i dr. - Moskva: NCSSH im. A.N. Bakuleva RAMN, 2002. - 417 s.

10. Tepljakov A.T., Grakova E.V. Hronicheskaja serdechnaja nedostatochnost’. Jeffektivnost’ revaskuljarizacii ishemizirovannogo miokarda. Tomsk: STT, 2014; 260 p.

11. Ishemicheskaja bolezn’ serdca u bol’nyh s nizkoj sokratitel’noj sposobnost’ju miokarda levogo zheludochka (diagnostika, taktika lechenija). L.A. Bokerija, V.S. Rabotnikov, Ju.I. Buziashvili, S.K. Chinaliev. - Moskva: NCSSH im. A.N. Bakuleva RAMN, 2001; 195 s.

12. Chumakova G.A., Veselovskaja N.G., Kozarenko A.A. Faktory riska restenozov posle revaskuljarizacii miokarda u pacientov s metabolicheskim sindromom i saharnym diabetom 2 tipa. Serdce. 2010; Tom 9. №1: 14-19.

13. Flaherty J.D., Davidson C.J. Diabetes and coronary revascularization. JAMA 2005; 293: 1501. doi: 10.1001/jama.293.12.1501.

14. ESC / EACTS Recommendations for myocardial revascularization. Russian Journal of Cardiology. 2015; 2 (118). Access Date 08.07.2016. Available from: http://www.scardio.ru/content/Guidelines/recomend_2_rkj_15.pdf.

15. Russian Association of Endocrinologists. Clinical guidelines «Algorithms of specialized medical care for patients with diabetes,» 6th edition, ed. Dedov II, Shestakova MV Moscow: Endocrinology Research Center. 2013. 120 p.

16. Sumin A.N., Bezdenezhnyh N.A., Bezdenezhnyh A.V., Ivanov S.V., Belik E.V., Barbarash O.L. Factors associated with in-hospital mortality after coronary artery bypass grafting in patients with CHD and type 2 diabetes. Saharnyj diabet. 2014; 4: 25-34.

17. van Melle J.P., Bot M., de Jonge P. et al. Diabetes, Glycemis Control, and New-Onset Heart Failure in Patients With Stable Coronary Artery Disease. Diabetes Care. 2010; 33 (9): 2084-2089. doi: 10.2337/dc10-0286.

18. Keelan P.C., Johnston J.M., Koru-Sengul T. et al. Comparison of in-hospital and one-year outcomes in patients with left ventricular ejection functions ≤40%, 41% to 49% and ≥50% having percutaneous coronary revascularization. Am J Cardiol. 2003; 91: 1168. doiI: 10.1016/S0002-9149 (03) 00261-3.

19. Teplyakov A.T., Kuznetsova A.V., Protopopova N.V., Andriyanova A.V., Suslova T.E., Nasanova O.N., Kalyuzhin V.V. Lipoprotein-associated phospholipase a2 in cardiovascular risk stratification after coronary angioplasty in patients with type 2 diabetes: which decision rule threshold to choose?. Bulletin of Siberian Medicine. 2015;14(2):47-54. (In Russ.) doi:10.20538/1682-0363-2015-2-47-54.

20. Shoukrya A., El-Sherbienyb I. Association of insulin resistance, insulin and leptin levels with coronary in-stent restenosis. The Egyptian Heart Journal. 2012; V64, I1: 35-42. doi: 10.1016/j.ehj.2011.08.005.

21. Zhuravleva L.V., Kuznecov I.V., Lopina N.A. Osobennosti porazhenija koronarnyh arterij, problemy restenozirovanija posle procedur revaskuljarizacii u bol’nyh s saharnym diabetom 2 tipa. Therapia. 2015; 9 (101): 8–13.