Myocardial revascularization in diabetic patients presenting with critical limbischemia

The frequency of diabetic complications remains high despite the development of improved therapeutic modalities. Macroangiopathy continues to bethe predominant complication while coronary heart disease is the main cause of mortality.This paper considers clinical features of diabetic patientswith coronary heart disease and critical limb ischemia; various aspects of optimal drug therapy, preoperative examination and diagnostics precedingvascular non-cardiac surgery; preoperative risk assessment; indications for coronary angiography and myocardial revascularization. The authors emphasizethe importance of development of algorithms for the treatment of patients with diabetes, critical limb ischemia, and coronary heart disease

Ischaemic heart disease in patients with diabetes mellitus and critical lower limb ischemia

Aims. 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

Severe neuropathy in a patient with ischemic heart disease and type 2 diabetes

The article describes a variety of severe clinical manifestations of diabetic autonomic neuropathy in patients with type 2 diabetes mellitus and coronary heart disease. The peculiarity of this case is the simultaneous onset of autonomic neuropathy and lesions of the cardiovascular system, complications of untreated diabetes, without acute decompensation in carbohydrate metabolism

Interventional cardiology and diabetes mellitus: age of effective coronary heart disease treatment

Introduction into clinical practice of coronary angioplasty has provided new possibilities for treatment of coronary heart disease (CHD) in patientswith diabetes mellitus. The indications for endovascular interventions and principles of coronary stenting in such patients are described in this article

bFGF and TGFbeta1 growth factors, inflammatory markers (IL-6, TNF-alpha, CRP) and advanced glycation end-products (AGE, RAGE) in patients with ischemic heart disease and type 2 diabetes mellitus

Aims. To evaluate plasma levels of transforming growth factor beta (TGFbeta1), basic fibroblast growth factor (bFGF), markers for nonspecific inflammatory process (interleukin-6 (IL-6), tumor necrosis factor alpha (TNF-alpha), C-reactive protein (CRP)) and their putative correlation with advanced glycation end-products relative to diabetes compensation in patients with ischemic heart disease (IHD). Materials and Methods. 87 patients with IHD were enrolled in this study. All subjects underwent standard clinical examination, including laboratory assessment of glycemic parameters, lipid panel and renal function, with echocardiography, supplemented with coronary angiography. Analyses for study parameters were performed on samples obtained from aorta and, separately, from cubital vein during coronary angiography. Results. Diabetes mellitus in patients with IHD is firmly associated with TGFbeta1, IL-6 and CRP elevation in both arterial and venous plasma. TGFbeta1 positively correlates with lipid profile parameters. Plasma concentration of inflammatory markers and advanced glycation end-products positively correlates with the extent of coronary lesions in relation to the presence of diabetes mellitus. Conclusion. Our data suggests the interplay between connective tissue growth factors and lipid metabolism in the atherosclerotic process