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Reduced coronary collateralization in type 2 diabetic patients with chronic total occlusion.
Reduced coronary collateralization in type 2 diabetic patients with chronic total occlusion.
- Source :
-
Cardiovascular diabetology [Cardiovasc Diabetol] 2018 Feb 08; Vol. 17 (1), pp. 26. Date of Electronic Publication: 2018 Feb 08. - Publication Year :
- 2018
-
Abstract
- Background: The extent of coronary collateral formation is a primary determinant of the severity of myocardial damage and mortality after coronary artery occlusion. Type 2 diabetes mellitus (T2DM) represents an important risk factor for impaired collateral vessel growth. However, the mechanism of reduced coronary collateralization in type 2 diabetic patients remains unclear.<br />Methods: With the reference to the recent researches, this review article describes the pathogenic effects of T2DM on collateral development and outlines possible clinical and biochemical markers associated with reduced coronary collateralization in type 2 diabetic patients with chronic total occlusion (CTO).<br />Results: Diffuse coronary atherosclerosis in T2DM reduces pressure gradient between collateral donor artery and collateral recipient one, limiting collateral vessel growth and function. An interaction between advanced glycation end-products and their receptor activates several intracellular signaling pathways, enhances oxidative stress and aggravates inflammatory process. Diabetic condition decreases pro-angiogenic factors especially vascular endothelial growth factor and other collateral vessel growth related parameters. Numerous clinical and biochemical factors that could possibly attenuate the development of coronary collaterals have been reported. Increased serum levels of glycated albumin, cystatin C, and adipokine C1q tumor necrosis factor related protein 1 were associated with poor coronary collateralization in type 2 diabetic patients with stable coronary artery disease and CTO. Diastolic blood pressure and stenosis severity of the predominant collateral donor artery also play a role in coronary collateral formation.<br />Conclusions: T2DM impairs collateral vessel growth through multiple mechanisms involving arteriogenesis and angiogenesis, and coronary collateral formation in patients with T2DM and CTO is influenced by various clinical, biochemical and angiographic factors. This information provides insights into the understanding of coronary pathophysiology and searching for potential new therapeutic targets in T2DM.
- Subjects :
- Animals
Coronary Artery Disease blood
Coronary Artery Disease diagnostic imaging
Coronary Artery Disease epidemiology
Coronary Occlusion blood
Coronary Occlusion diagnostic imaging
Coronary Occlusion epidemiology
Coronary Vessels diagnostic imaging
Coronary Vessels metabolism
Diabetes Mellitus, Type 2 blood
Diabetes Mellitus, Type 2 diagnosis
Diabetes Mellitus, Type 2 epidemiology
Diabetic Angiopathies blood
Diabetic Angiopathies diagnostic imaging
Diabetic Angiopathies epidemiology
Glycation End Products, Advanced blood
Humans
Inflammation Mediators blood
Oxidative Stress
Prognosis
Receptor for Advanced Glycation End Products metabolism
Risk Factors
Signal Transduction
Vascular Endothelial Growth Factor A blood
Collateral Circulation
Coronary Artery Disease physiopathology
Coronary Circulation
Coronary Occlusion physiopathology
Coronary Vessels physiopathology
Diabetes Mellitus, Type 2 physiopathology
Diabetic Angiopathies physiopathology
Neovascularization, Pathologic
Subjects
Details
- Language :
- English
- ISSN :
- 1475-2840
- Volume :
- 17
- Issue :
- 1
- Database :
- MEDLINE
- Journal :
- Cardiovascular diabetology
- Publication Type :
- Academic Journal
- Accession number :
- 29422093
- Full Text :
- https://doi.org/10.1186/s12933-018-0671-6