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

Abstract

BackgroundThe influence of diabetes mellitus on myocardial ischemic preconditioning is not clearly defined. Experimental studies are conflicting and human studies are scarce and inconclusive.ObjectivesIdentify whether diabetes mellitus intervenes on ischemic preconditioning in symptomatic coronary artery disease patients.MethodsSymptomatic 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.ResultsOf 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).ConclusionsIn 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.

Mitochondrial aldehyde dehydrogenase obliterates insulin resistance-induced cardiac dysfunction through deacetylation of PGC-1α

“…In our hands, sucrose diet-induced insulin resistance triggered myocardial contractile defects including enlarged LVESD, reduced fractional shortening, peak shortening, ± dL/dt and prolonged TR 90 in the absence of overt change in cardiomyocyte cross-sectional area. These findings are somewhat in agreement with the previous notion of myopathic changes in chronic alcoholism-, insulin resistant- and diabetic cardiomyopathy [4, 6, 9, 15, 17, 18, 37-39]. Our data revealed interrupted intracellular Ca 2+ homeostasis in response to sucrose diet intake manifested as depressed baseline, peak and electrically-stimulated rise in intracellular Ca 2+ , as well as prolonged intracellular Ca 2+ decay, denoting an essential role of intracellular Ca 2+ dysregulation in insulin resistance-induced cardiomyopathy.…”

“…Insulin resistance is associated with accumulation of reactive oxygen species (ROS), oxidative stress, onset and development of cardiac dysfunction possibly related to peroxidation of lipids and proteins, mitochondrial damage, and changes in excitation contraction coupling proteins [5]. Earlier work from our group and others has depicted that sucrose diet intake triggers whole body insulin resistance and cardiac dysfunction [6-8], which is in line with the clinical manifestations of cardiac dysfunction and increased mortality among patients with insulin resistance and type 2 diabetes [9]. Framingham Heart Study also correlates soft drink consumption with an increased incidence of metabolic risk, suggesting a close tie between carbonhydrate intake and metabolic diseases [10].…”

Efficacy of Physical Trainings as Cardioprotection Method for Coronary Bypass Surgery

“…Одним из методов защиты миокарда от реперфузионного повреждения может выступать ишемическое прекондиционирование. Ши-роко известны методы интраоперационной кардиопро-текции, эффективность которых доказана многочи-сленными исследованиями: локальное ишемическое [2] и анестетическое прекондиционирование [3]. Данные методики широко внедрены в практику, однако, несмот ря на достижения кардиохирургии и кардиоане-стезиологии, частота развития интраоперационных инфарк тов миокарда остается высокой [4].…”

“…, Barbarash О. L. 1,2 Aim. To assess efficacy and safety of inclusion of physical trainings to the program of patients prehabilitation before coronary bypass (CBG) on-pump, from the perspective of cardioprotection.…”

Potential Benefits of Exercise Training as a Factor of Ischemic Preconditioning Prior to Coronary Artery Bypass Grafting (Review)

“…В дальнейшем инфарктлимитирующий эф-фект ишемического прекондиционирования был подтвержден на многих экспериментальных мо-делях [13]. По данным Национального институ-та сердца, легких и крови (США), ишемическое прекондиционирование наряду с ранней репер-фузией является одним из наиболее эффектив-ных методов защиты миокарда от ишемического и реперфузионного повреждения [14,15].…”