Ljubica Georgievska-Ismail, Vladimir Borozanov, Marija Vavlukis, Lidija Poposka and Marijan Bosevski
Occurrence and Progression of Coronary Artery Disease in Patients with Type 2 Diabetes
Aim. The aims of reaserch project were to determine the predictive role of diabetes type 2 as independent factor and/or in correlation with others in occurrence, extent and prognosis of CAD, as well as to evaluate the feasibility, safety and the effect of an aggressive control of risk factors, multifactoral medicament therapy and application of revascularization procedures in individuals prone to or with already manifested diabetes.
Material and methods. The research covered prospectively 30 individuals with type 2 diabetes (age 53.3 ± 3.1, mean diabetes duration 7.5 years) with presence of insulin resistance syndrome's componentes and retrospectively/ prospectively 333 patients with manifested diabetes type 2 and CAD (age 60.4 ± 8.23, mean diabetes duration 8.5 years).
Results. History of myocardial infarction corelates with obesity and hypoHDLemia. Dyslipidemia with the presence of chest pain in objective clinician state, and symptom of angina grade CCS3 correlates with presence of microvascular complications, and CCS1 angina with use of insulin in diabetes treatment. Gensini score, angiographicly estimated, was in multivariate relation with dyslipidemia and systolic pressure. Among pts undergone coronary surgery as predictor of by pass graft stenosis was found physical inactivity, and among pts undergone percutaneus revascularization, carotid IMT for in stent restenosis.
Conclusions. High prevalence of insulin resistance syndrome' components: arterial hypertension and dyslipidemia were found in type 2 diabetes patients, who did not presented CAD. Symptomatic CAD, occurred in 6.7% od these pts was only in relation with the hypoHDLemia.
Emilija Sandevska, Daniela Pop Gjorcheva, Marija Vavlukis, Aleksandar Sandevski, Irena Kafedziska, Ljubinka Krstik-Damjanovska, Venjamin Majstorov, Sasha Jovanovska-Perchinkova, Filip Guchev and Nela Kostova
Introduction: Atherosclerosis in young and premenopausal women with systemic lupus erythematosus (SLE) is frequent, premature and progressive. Although asymptomatic or with atypical clinical presentation, the patients are at high risk of cardiac events. Aim of this study is to estimate the risk profile for atherogenesis and the prevalence of myocardial perfusion abnormalities with 99mTc myocardial perfusion scintigraphy (MPS) in young and premenopausal women.
Material and methods: Sixty female patients, aged 30-72 years (divided into two subgroups - patients under 45 years of age and patients over 45 years), diagnosed with SLE for over of 5 years, in active phase of the disease were analyzed for disease activity scores (SLEDAI), the immunologic status of the disease (ANA and a-DNA antibodies in the serum), procoagulant tendency (antiphospholipid antibodies-APhL and lupus-anticoagulant-LAC), the activity of the inflammatory process (hsCRP), the anti-SLE therapeutic approach and the presence of traditional risk factors for atherosclerosis (BMI, smoking, hypertension, hyperlipidemia, diabetes, and familial history for the CAD). Using one-day Dipyridamol – Rest 99mTc SPECT Gated MPS SPECT the extent, severity and reversibility of myocardial perfusion abnormalities were estimated, along with summed scores at stress, rest and summed difference scores and left ventricle volumes and ejection fraction.
Results: Abnormal MPS SPECT were detected in 27/60 or in 45% of patients, with one vessel affection of 66.7% (18/27pts) of LAD and 14.8% (4/27pts) o RCA and with two vessel disease of LAD/RCA in 2/27 pts (7.4%) and LAD/Cx in 3/27pts (11.1%). Myocardial perfusion abnormalities were equally prevalent in subgroups of patients younger than 45 years (44,4%) and in patients older than 45 years (45.5%) (ns). The subgroups did not differ significantly concerning the extent of perfusion abnormalities (9,8±3.2% of LV myocardial mass vs. 9,8±7.1%,ns), their severity (with predominance of mild perfusion defects, 48,6% vs. 51,3%,ns) and reversibility (reversible in 41.3% and 58.6%, ns). The differences between the summed scores of severity and the extent of ischemia in the two subgroups were statistically nonsignificant. Younger patients had significantly higher end-diastolic, end-systolic and stroke volumes during stress and rest conditions, compared to older patients (p<0,01) although there were no differences in systolic function, which was not affected in either of the groups as expressed threw ejection fraction.
Although nonsignificant, younger patients had higher values of hsCRP and higher procoagulant activity (positive aPhL, LAC) while they were with more active disease activity, with higher SLEDAI score compared to older patients (p=0.028). Higher SLEDAI score and LV volumes, especially EDV at stress were identified as predictor of abnormal MPS in younger groups and more aggressive multidrug anti SLE treatment as predictor of normal MPS.
Conclusion: The prevalence and characteristics of myocardial perfusion abnormalities in young SLE are equal as the same in older SLE patients, which indicates the presence of premature, accelerated atherosclerosis in young cohort of patients with SLE. Younger SLE patients with pure disease control (higher SLEDAI score, less aggressive treatment, high hsCRP values and pronounced procoagulant tendency) should undergo screening for myocardial perfusion abnormalities s using 99mTc MIBI MPS)
Marija Vavlukis, Biljana Zafirovska, Emilija Antova, Bekim Pocesta, Enes Shehu, Hajber Taravari, Irena Kotlar, Darko Kitanovski, Danica Petkoska, Ivan Vasilev, Filip Janusevski, Ivica Bojovski and Sashko Kedev
Objective: The aim of the study was to assess the prevalence of newly diagnosed diabetes in patients with acute coronary syndrome and estimate the relationship between stress hyperglycemia, glyco-regulation and newly diagnosed diabetes with hospital morbidity and mortality.
Methods: This was an observational study which included all patients hospitalized due to acute coronary syndrome (January 2015 until April 2017) at the University Clinic of Cardiology in Skopje, Macedonia. We analyzed demographic, clinical, biochemical variables and hospital morbidity and mortality. Five investigated groups were compared using a single biochemical parameter glycated hemoglobin (HgbA1c) depending on the presence of known diabetes before the acute event: 0-without DM (HgbA1c <5.6%), 1-newly diagnosed pre-diabetes (HgbA1c 5.6-6.5%), 2-newly diagnosed diabetes (HgbA1c ≥ 6.5%), 3-known well controlled diabetes (HgbA1c <7%) and 4-known un-controlled diabetes (HgbA1c ≥7%).
Results: 860 patients were analyzed. Impaired glucose metabolism was confirmed in 35% of patients, 9% of which were with newly diagnosed diabetes. Stress hyperglycemia was reported in 27.3% (3.6% were without diabetes). The highest values of stress hyperglycemia were reported in newly diagnosed and known un-controlled diabetes. In-hospital morbidity and mortality were 15% and 5% accordingly and the rate was highest in patients with newly diagnosed and known, but un-controlled diabetes. HgbA1c, stress hyperglycemia, and poor glycemic control have emerged as significant independent predictors of hospital morbidity and mortality in patients with acute coronary syndrome.
Conclusion: High prevalence of newly diagnosed diabetes was observed in patients with acute coronary syndrome. Stress hyperglycemia and failure to achieve glycemic control are independent predictors of hospital morbidity and mortality.