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. 2015 May 30:14:66.
doi: 10.1186/s12933-015-0228-x.

Type 2 diabetes mellitus and myocardial ischemic preconditioning in symptomatic coronary artery disease patients

Paulo Cury Rezende  1 , Rosa Maria Rahmi  2 , Augusto Hiroshi Uchida  3 , Leandro Menezes Alves da Costa  4 , Thiago Luis Scudeler  5 , Cibele Larrosa Garzillo  6 , Eduardo Gomes Lima  7 , Carlos Alexandre Wainrober Segre  8 , Priscyla Girardi  9 , Myrthes Takiuti  10 , Marcela Francisca Silva  11 , Whady Hueb  12 , Jose Antonio Franchini Ramires  13 , Roberto Kalil Filho  14
Affiliations

Type 2 diabetes mellitus and myocardial ischemic preconditioning in symptomatic coronary artery disease patients

Paulo Cury Rezende et al. Cardiovasc Diabetol. .

Abstract

Background: The influence of diabetes mellitus on myocardial ischemic preconditioning is not clearly defined. Experimental studies are conflicting and human studies are scarce and inconclusive.

Objectives: Identify whether diabetes mellitus intervenes on ischemic preconditioning in symptomatic coronary artery disease patients.

Methods: Symptomatic multivessel coronary artery disease patients with preserved systolic ventricular function and a positive exercise test underwent two sequential exercise tests to demonstrate ischemic preconditioning. Ischemic parameters were compared among patients with and without type 2 diabetes mellitus. Ischemic preconditioning was considered present when the time to 1.0 mm ST deviation and rate pressure-product were greater in the second of 2 exercise tests. Sequential exercise tests were analyzed by 2 independent cardiologists.

Results: Of the 2,140 consecutive coronary artery disease patients screened, 361 met inclusion criteria, and 174 patients (64.2 ± 7.6 years) completed the study protocol. Of these, 86 had the diagnosis of type 2 diabetes. Among diabetic patients, 62 (72 %) manifested an improvement in ischemic parameters consistent with ischemic preconditioning, whereas among nondiabetic patients, 60 (68 %) manifested ischemic preconditioning (p = 0.62). The analysis of patients who demonstrated ischemic preconditioning showed similar improvement in the time to 1.0 mm ST deviation between diabetic and nondiabetic groups (79.4 ± 47.6 vs 65.5 ± 36.4 s, respectively, p = 0.12). Regarding rate pressure-product, the improvement was greater in diabetic compared to nondiabetic patients (3011 ± 2430 vs 2081 ± 2139 bpm x mmHg, respectively, p = 0.01).

Conclusions: In this study, diabetes mellitus was not associated with impairment in ischemic preconditioning in symptomatic coronary artery disease patients. Furthermore, diabetic patients experienced an improvement in this significant mechanism of myocardial protection.

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Figures

Fig. 1
Fig. 1
Study flow chart. Of the 2,140 initial CAD patients screened, 361 met the inclusion criteria and were enrolled, and 174 completed the study protocol. The study population comprised 86 diabetic and 88 nondiabetic patients. CAD = coronary artery disease; CKD = chronic kidney disease; CVA = cerebrovascular accident; ECG = electrocardiogram; EF = ejection fraction; ET = exercise test; DM = diabetes mellitus; IP = ischemic preconditioning; SET = sequential exercise test (s)
Fig. 2
Fig. 2
Pie charts showing the number and percentage of diabetic and nondiabetic patients who demonstrated IP. IP = ischemic preconditioning
Fig. 3
Fig. 3
Graphs showing the percentage of patients who demonstrated ischemic preconditioning (IP+ in blue) and who did not demonstrate ischemic preconditioning (IP - in red) stratified into quartiles of A1c (graph a) and Fasting Glycemia (graph b). IP = ischemic preconditioning; Q = quartile (s). X axis represents the percentage of patients and Y axis the quartiles of A1c and Fasting Glycemia
See this image and copyright information in PMC

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