The Anatolian Journal of Cardiology

Diyabetes Mellitus’ta Azalmış Koroner Kollateral Damar Açılma Kapasitesi: Defektif İskemik Tolerans için Bir Kanıt [Anatol J Cardiol]
Anatol J Cardiol. 2004; 4(1): 54-58

Diyabetes Mellitus’ta Azalmış Koroner Kollateral Damar Açılma Kapasitesi: Defektif İskemik Tolerans için Bir Kanıt

Murat Sezer1, Yılmaz Nişancı2, Berrin Umman3, Sabahattin Umman4, Ercüment Yılmaz3, Faruk Erzengin3, Ayhan Olcay5, Önal Özsaruhan3
1Istanbul Faculty of Medicine, Istanbul University, Cardiology, İstanbul
2İstanbul Tıp Fakültesi, Kardiyoloji Anabilim Dalı, istanbul
3İstanbul Üniversitesi, İstanbul Tıp Fakültesi, Kardiyoloji Anabilim Dalı, Çapa-İstanbul
4İstanbul Üniversitesi İstanbul Tıp Fakültesi, Kardiyoloji Anabilim Dalı, İstanbul, Türkiye
5Department of Cardiology, İstanbul School of Medicine, İstanbul University İstanbul, Turkey

Anahtar Kelimeler: Diyabet, iskemik koşullanma, koroner kollateral


Reduced Coronary Collateral Vessel Recruitment Capacity in Diabetes Mellitus: An Evidence for Defective Ischaemic Tolerance

Murat Sezer1, Yılmaz Nişancı2, Berrin Umman3, Sabahattin Umman4, Ercüment Yılmaz3, Faruk Erzengin3, Ayhan Olcay5, Önal Özsaruhan3
1Istanbul Faculty of Medicine, Istanbul University, Cardiology, İstanbul
2İstanbul Tıp Fakültesi, Kardiyoloji Anabilim Dalı, istanbul
3İstanbul Üniversitesi, İstanbul Tıp Fakültesi, Kardiyoloji Anabilim Dalı, Çapa-İstanbul
4İstanbul Üniversitesi İstanbul Tıp Fakültesi, Kardiyoloji Anabilim Dalı, İstanbul, Türkiye
5Department of Cardiology, İstanbul School of Medicine, İstanbul University İstanbul, Turkey

Objective: Collateral channel opening is one of the components of the ischemic tolerance developing during subsequent coronary balloon occlusions. The effect of diabetes mellitus (DM) on coronary collateral recruitment (CR) is still not known. We therefore sought the effect of DM on CR in patients with stable angina pectoris (SAP) by using intracoronary pressure measurement technique. Methods: Study material consisted of 44 patients (21 diabetic) with SAP. All of the patients had single vessel disease with more than 70% vessel narrowing and all of them underwent stent implantation to this vessel. After angiography, fiber-optic pressure monitoring guide-wire was advanced distal to the stenosis to be dilated. Myocardial fractional flow reserve (FFRmyo) was determined under adenosine hyperemia by the ratio of simultaneously measured mean distal pressure to mean aortic pressure. During subsequent two 1 minute balloon occlusions, distal pressures were recorded as coronary wedge pressure (CWP). Collateral flow index was determined by the ratio of simultaneously measured CWP to mean aortic pressure. Percentage of the improvement in the coronary flow index (CFI) (first to second occlusion) between two occlusions was determined for each patient. Results: There was no difference between two groups in terms of pre-intervention FFRmyo (0.54 ± 0.12 in DM group and 0.50 ± 0.11 in non-DM group). The baseline CFI was significantly higher in non-DM group (0.26 ± 0.09 versus 0.17 ± 0.08, p<0.03). Beyond this finding, mean CFI increased by 17% (from 0.17 ± 0.08 to 0.20 ± 0.09) in DM group and by 30 % (from 0.26 ± 0.09 to 0.34 ± 0.10) in non- DM group. There was statistically significant difference between these two groups in terms of improvement in CFI during subsequent balloon occlusions (p<0.01). Conclusion: In addition to poor collateral vessels seen in patients with DM, CR is also impaired. This finding suggests that DM abolishes ischemic tolerance in terms of CR as well.

Keywords: Diyabet, iskemik koşullanma, koroner kollateral


Murat Sezer, Yılmaz Nişancı, Berrin Umman, Sabahattin Umman, Ercüment Yılmaz, Faruk Erzengin, Ayhan Olcay, Önal Özsaruhan. Reduced Coronary Collateral Vessel Recruitment Capacity in Diabetes Mellitus: An Evidence for Defective Ischaemic Tolerance. Anatol J Cardiol. 2004; 4(1): 54-58


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