Structural and functional changes in the myocardium in chronic coronary syndrome and type 2 diabetes mellitus depending on the number of affected coronary arteries

Background. The study of structural and functional changes of the myocardium in patients with chronic coronary syndrome and type 2 diabetes mellitus makes it possible to identify early processes of cardiac remodeling, diastolic dysfunction, to assess the degree of coronary involvement. Purpose – is to investigate the relationship between the state of systolic and diastolic myocardial functions and the level of N-terminal pro–B-type natriuretic peptide in patients with chronic coronary syndrome with concomitant type 2 diabetes mellitus taking into account the degree of coronary artery involvement according to coronary angiography. Materials and Methods. The object of the study was 95 patients with exertional angina who underwent coronary angiography. The main group consisted of 60 individuals (63.2%) with exertional angina in combination with type 2 diabetes mellitus. The comparison group included 35 patients with a verified analogous cardiological diagnosis without concomitant type 2 diabetes mellitus. Results. In patients with exertional angina and type 2 diabetes mellitus, coronary angiography more frequently revealed multivessel coronary artery disease. These patients showed a significant increase in left atrial size, left ventricular end-diastolic and end-systolic volumes. Left ventricular ejection fraction decreased with increasing severity of coronary artery involvement and was significantly lower in patients with type 2 diabetes mellitus. In the examined patients with combined pathology, the ratio of transmitral flow velocities was significantly lower, especially in those with multivessel coronary artery disease, indicating pronounced myocardial relaxation impairment. In both patient groups, a reduction in global longitudinal myocardial strain was observed, particularly in individuals with multivessel coronary artery involvement against the background of concomitant pathology. In patients with chronic coronary syndrome and multivessel coronary artery disease, a significant increase in the level of N-terminal pro–B-type natriuretic was noted. Conclusions. In patients with chronic coronary syndrome combined with type 2 diabetes mellitus the progression of chronic heart failure increases with the rise in the number of affected coronary arteries. The changes manifest as dilation of the left ventricular cavity and its hypertrophy, diastolic dysfunction, a decrease in left ventricular ejection fraction and the index of global longitudinal myocardial strain of the left ventricle, an increase in the level of N-terminal pro–B-type natriuretic peptide.