Ischaemic heart disease in patients with diabetes mellitus and critical lower limb ischemia
https://doi.org/10.14341/2072-0351-6084
Abstract
To assess prevalence of ischemic heart disease (IHD) and clinical features of asymptomatic IHD in patients with diabetes mellitus(DM) and critical lower limb ischemia (LLI).Materials and Methods.
We examined 118 patients with DM, who underwent hospitalization for critical LLI. Besides routinecardiologic examination, all patients were subject to color duplex ultrasonography of lower limbs and CT contrast angiography. Patientswith proper indications underwent coronary angiography. Statistical data was processed with SPSS v17.0.0. software package.
Results.
We have found 58.5% of patients with DM and critical LLI to suffer from IHD - and approximately 40% to have myocardialinfarction in their medical history. According to acquired coronary angiograms, 89% of asymptomatic cases were characterized byhemodynamically significant stenosis, while 68.7% of them had either three arteries affected or left main coronary artery lesions.
Conclusion.
Patients with DM and critical LLI require thorough examination, as subclinical IHD may be masked in them by lowerlimb angiopathy.
About the Authors
Konstantin Vladimirovich MelkozerovVictor Yur'evich Kalashnikov
Sergey Anatol'evich Terekhin
Olga Nikolaevna Bondarenko
References
1. Norman PE, Davis WA, Bruce DG, Davis TM. Peripheral arterial disease and risk of cardiac death in type 2 diabetes: the Fremantle Diabetes Study. Diabetes Care. 2006; 29(3):575-580.
2. Leibson CL, Ransom JE, Olson W, Zimmerman BR, O'fallon WM, Palumbo PJ. Peripheral arterial disease, diabetes, and mortality. Diabetes Care. 2004; 27(12):2843-2849.
3. Weckbach S, Findeisen HM, Schoenberg SO, Kramer H, Stark R, Clevert DA, Reiser MF, Parhofer KG. Systemic cardiovascular complications in patients with long-standing diabetes mellitus: comprehensive assessment with whole-body magnetic resonance imaging/magnetic resonance angiography. Invest Radiol. 2009 Apr;44(4):242-250.
4. Natarajan S, Liao Y, Sinha D, Cao G, McGee DL, Lipsitz SR. Sex Differences in the Effect of Diabetes Duration on Coronary Heart Disease Mortality. Arch Intern Med. Feb.28, 2005;165(4):430-435.
5. Dormandy JA, Rutherford RB. Management of peripheral arterial disease (PAD). TASC Working Group. TransAtlantic Inter-Society Consensus (TASC). J Vasc Surg. 2000 Jan;31(1 Pt 2):S1-S296.
6. Norgren L, Hiatt WR, Dormandy JA, Nehler MR, Harris KA, Fowkes FG; TASC II Working Group. Inter-society consensus for the management of peripheral arterial disease (TASC II). J Vasc Surg. 2007 Jan;45 Suppl S:S5-67.
7. Critical limb ischemia, A PUBLICATION OF NATIONAL HEALING CORPORATION. Available from: http://www.nationalhealing. comdownloadsnhcwhpspring06.pdf
8. McFalls EO, Ward HB, Moritz TE, Goldman S, Krupski WC, Littooy F, Pierpont G, Santilli S, Rapp J, Hattler B, Shunk K, Jaenicke C, Thottapurathu L, Ellis N, Reda DJ, Henderson WG. Henderson WG. Coronary-artery revascularization before elective major vascular surgery. N Engl J Med. 2004 Dec 30;351(27):2795-2804.
9. Steg PG, Bhatt DL, Wilson PW, D'Agostino R Sr, Ohman EM, Röther J, Liau CS, Hirsch AT, Mas JL, Ikeda Y, Pencina MJ, Goto S; REACH Registry Investigators. One-year cardiovascular event rates in outpatients with atherothrombosis. JAMA. 2007 Mar 21;297(11):1197-1206.
10. Grundy SM, Cleeman JI, Merz CN, Brewer HB Jr, Clark LT, Hunninghake DB, Pasternak RC, Smith SC Jr, Stone NJ; National Heart, Lung, and Blood Institute; American College of Cardiology Foundation; American Heart Association. Implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III guidelines [published correction appears in Circulation. 2004;110(6):763]. Circulation. 2004;110(2):227-239.
11. Abramson BL, Huckell V, Anand S, Forbes T, Gupta A, Harris K, Junaid A, Lindsay T, McAlister F, Roussin A, Saw J, Teo KK, Turpie AG, Verma S; Canadian Cardiovascular Society. Canadian cardiovascular society Consensus Conference: Peripheral arterial disease - executive summary. Can J Cardiol. 2005 Oct;21(12):997-1006.
12. Allie DE, Hebert CJ, Lirtzman MD, Wyatt CH, Keller VA, Khan MH, Khan MA, Fail PS, Vivekananthan K, Allie SE, Mitran EV, Chaisson G, Stagg SJ 3rd, Allie AA, McElderry MW, Barker EA, Walker CM. A safety and feasibility report of combined direct thrombin and GP IIb/IIIa inhibition with bivalirudin and tirofiban in peripheral vascular disease intervention: treating critical limb ischemia like acute coronary syndrome. J Invasive Cardiol. 2005 Aug;17(8):427-432.
13. Singh M, Lennon RJ, Darbar D, Gersh BJ, Holmes DR Jr, Rihal CS. Effect of peripheral arterial disease in patients undergoing percutaneous coronary intervention with intracoronary stents. Mayo Clin Proc. 2004 Sep;79(9):1113-1118.
14. Saw J, Bhatt DL, Moliterno DJ, Brener SJ, Steinhubl SR, Lincoff AM, Tcheng JE, Harrington RA, Simoons M, Hu T, Sheikh MA, Kereiakes DJ, Topol EJ. The influence of peripheral arterial disease on outcomes: a pooled analysis of mortality in eight large randomized percutaneous coronary intervention trials. J Am Coll Cardiol. 2006 Oct 17;48(8):1567-1572. Epub 2006 Sep 26.
15. Guidelines on diabetes, pre-diabetes, and cardiovascular diseases. European Heart Journal. Available from: http://www. escardio.org/guidelines-surveys/esc-guidelines/Guidelines- Documents/guidelines-diabetes-FT.pdf
16. American Diabetes Association. Standards of Medical Care in Diabetes Diabetes care. 2010; 33, supplement 1:S11-61.
17. Vergès B, Avignon A, Bonnet F, Catargi B, Cattan S, Cosson E, Ducrocq G, Elbaz M, Fredenrich A, Gourdy P, Henry P, Lairez O, Leguerrier AM, Monpère C, Moulin P, Vergès- Patois B, Roussel R, Steg G, Valensi P; Diabetes and Cardiovascular Disease study group of the Société francophone du diabète (SFD), in collaboration with the Société française de cardiologie (SFC). Consensus statement on the care of the hyperglycaemic/diabetic patient during and in the immediate follow-up of acute coronary syndrome. Diabetes Metab. 2012 Apr;38(2):113-127. Epub 2011 Dec 30.
18. Hirsch AT, Haskal ZJ, Hertzer NR, Bakal CW, Creager MA, Halperin JL, Hiratzka LF, Murphy WR, Olin JW, Puschett JB, Rosenfield KA, Sacks D, Stanley JC, Taylor LM Jr, White CJ, White J, White RA, Antman EM, Smith SC Jr, Adams CD, Anderson JL, Faxon DP, Fuster V, Gibbons RJ, Hunt SA, Jacobs AK, Nishimura R, Ornato JP, Page RL, Riegel B; American Association for Vascular Surgery/Society for Vascular Surgery; Society for Cardiovascular Angiography and Interventions; Society for Vascular Medicine and Biology; Society of Interventional Radiology; ACC/AHA Task Force on Practice Guidelines ACC/AHA Guidelines for the Management of Patients with Peripheral Arterial Disease (lower extremity, renal, mesenteric, and abdominal aortic): a collaborative report from the American Associations for Vascular Surgery/Society for Vascular Surgery, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA Task Force on Practice Guidelines (writing committee to develop guidelines for the management of patients with peripheral arterial disease)-summary of recommendations. J Vasc Interv Radiol. 2006 Sep;17(9):1383-97; quiz 1398.
19. ESC Guidelines on the diagnosis and treatment of peripheral artery diseases. European Heart Journal. Available from: http:// www.escardio.org/guidelines-surveys/esc-guidelines/GuidelinesDocuments/ Guidelines-peripheral-AD-FT.pdf
20. Messerli FH, Mancia G, Conti CR, CJ Pepine. Guidelines on the management of stable angina pectoris. Eur Heart J (2006) 27(23): 2902-2903 first published online October 23, 2006 doi:10.1093/eurheartj/ehl308.
21. Hamm CW, Bassand JP, Agewall S, Bax J, Boersma E, Bueno H, Caso P, Dudek D, Gielen S, Huber K, Ohman M, Petrie MC, Sonntag F, Uva MS, Storey RF, Wijns W, Zahger D; ESC Committee for Practice Guidelines, Bax JJ, Auricchio A, Baumgartner H, Ceconi C, Dean V, Deaton C, Fagard R, Funck- Brentano C, Hasdai D, Hoes A, Knuuti J, Kolh P, McDonagh T, Moulin C, Poldermans D, Popescu BA, Reiner Z, Sechtem U, Sirnes PA, Torbicki A, Vahanian A, Windecker S; Document Reviewers, Windecker S, Achenbach S, Badimon L, Bertrand M, Bøtker HE, Collet JP, Crea F, Danchin N, Falk E, Goudevenos J, Gulba D, Hambrecht R, Herrmann J, Kastrati A, Kjeldsen K, Kristensen SD, Lancellotti P, Mehilli J, Merkely B, Montalescot G, Neumann FJ, Neyses L, Perk J, Roffi M, Romeo F, Ruda M, Swahn E, Valgimigli M, Vrints CJ, Widimsky P. ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Eur Heart J. 2011 Dec;32(23):2999-3054. doi: 10.1093/eurheartj/ ehr236. Epub 2011 Aug 26.
22. Guidelines on myocardial revascularization. Available from: http://www.escardio.org/guidelines-surveys/esc-guidelines/ GuidelinesDocuments/guidelines-revasc-FT.pdf
23. Definition and diagnosis of diabetes mellitus and intermediate hyperglycemia. Report of WHO/IDF Consultation, 2006 [Интернет]. Avialable from: http://www.who.int/diabetes/ publications/en/
24. Norgren L, Hiatt WR, Dormandy JA, Nehler MR, Harris KA, Fowkes FG; TASC II Working Group, Bell K, Caporusso J, Durand-Zaleski I, Komori K, Lammer J, Liapis C, Novo S, Razavi M, Robbs J, Schaper N, Shigematsu H, Sapoval M, White C, White J, Clement D, Creager M, Jaff M, Mohler E 3rd, Rutherford RB, Sheehan P, Sillesen H, Rosenfield K. Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II). Eur J Vasc Endovasc Surg. 2007;33 Suppl 1:S1-75. Epub 2006 Nov 29.
25. Национальные рекомендации по ведению пациентов с сосудистой артериальной патологией (Российский cогласительный документ). М: Изд-во НЦССХ им. А. Н. Бакулева РАМН; 2010. 176 с.
26. Национальные рекомендации по лечению ОКС без стойкого подъема ST на ЭКГ. Кардиоваскулярная терапия и профилактика. 2006;(5 прил. 1).
27. Российские рекомендации по диагностике и лечению стабильной стенокардии. Кардиоваскулярная терапия и профилактика 2008; 7(6), Приложение 4. Доступно: http:// www. scardio.ru/downloads/c4m0i225.pdf
28. Мареев ВЮ, Агеев ФТ, Арутюнов ГП, Коротеев АВ, Ревишвили АШ. Национальные рекомендации ВНОК и ОССН по диагностике и лечению хсн (третий пересмотр) (утверж- дены конференцией ОССН 15 декабря 2009 года). Журнал сердечная недостаточность. 2010;11(1):3-62.
29. Национальные рекомендации по диагностике и лечению ар- териальной гипертонии. Кардиоваскулярная терапия и профилактика. 2008;7(6 прил. 2).
30. Lavery LA, Armstrong DG, Harkless LB. Classification of diabetic foot wounds. J Foot Ankle Surg. 1996 Nov- Dec;35(6):528-31.
31. Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pellikka PA, Picard MH, Roman MJ, Seward J, Shanewise J, Solomon S, Spencer KT, St John Sutton M, Stewart W; American Society of Echocardiography's Nomenclature and Standards Committee; Task Force on Chamber Quantification; American College of Cardiology Echocardiography Committee; American Heart Association; European Association of Echocardiography, European Society of Cardiology. "Recommendations for chamber quantification". Eur J Echocardiogr. 2006 Mar;7(2):79-108. Epub 2006 Feb 2.
32. Lee TH, Marcantonio ER, Mangione CM, Thomas EJ, Polanczyk CA, Cook EF, Sugarbaker DJ, Donaldson MC, Poss R, Ho KK, Ludwig LE, Pedan A, Goldman L. Derivation and prospective validation of a simple index for prediction of cardiac risk of major noncardiac surgery. Circulation. 1999 Sep 7;100(10):1043-1049.
33. Fumeaux T, Cornuz J, Polikar R, Blanc E, Junod A, Kappenberger L, Nicod P, Schläpfer J. Guidelines for the clinical management of atrial fibrillation: a practical perspective. Swiss Med Wkly. 2004 May 1;134(17-18):235-247.
34. Serruys PW, Morice MC, Kappetein AP, Colombo A, Holmes DR, Mack MJ, Ståhle E, Feldman TE, van den Brand M, Bass EJ, Van Dyck N, Leadley K, Dawkins KD, Mohr FW; SYNTAX Investigators. Percutaneous Coronary Intervention versus Coronary-Artery Bypass Grafting for Severe Coronary Artery Disease. N Engl J Med. 2009 Mar 5;360(10):961-972. Epub 2009 Feb 18.
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For citations:
Melkozerov K.V., Kalashnikov V.Yu., Terekhin S.A., Bondarenko O.N. Ischaemic heart disease in patients with diabetes mellitus and critical lower limb ischemia. Diabetes mellitus. 2012;15(3):39-44. (In Russ.) https://doi.org/10.14341/2072-0351-6084

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