الفهرس 
Endothelial Function and DysfunctionOnly 14 pages are availabe for public view
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Abstract
this study was to assess the relation of flow mediated dilatation impairment and clinical and angiographic outcome in diabetic patients undergoing elective PCI.
This study was conducted on sixty diabetic patients with single vessel coronary artery stenting in Ain Shams University Hospital and 6-October Insurance Hospital from October 2007 to June 2008.
All patients were subjected to the following:
1. Complete History taking.
2. Complete clinical examination.
3. Echocardiography (ECHO).
4. Full laboratory investigations.
5. Elective percutaneous coronary angiography with single vessel stenting (PCI).
6. In hospital and 6 months out discharge follow up for any major cardiac adverse event (MACEs).
7. Flow mediated dilatation measurement (FMD) by Duplex U/S.
Patients were categorized according to FMD measurement into 2 groups:
Group (1): thirty patients with impaired flow mediated dilatation (median value<7%)
Group (II): thirty patients with normal flow mediated (median value ≥7%)
- All patients underwent exercise tolerance test/myocardial perfusion study.
- The study end point was clinical recurrence or documented evidence of ischemia on perfusion study and so re-angiography was done.
- In our study, forty four patients were males (77.3%), and sixteen patients were females (32.7%). Nearly half of the patients were NIDDM, hypertensive, smokers and dyslipidemics. Thirty-nine patients (69%) had family history of ischemic heart disease.
Forty-three patients (71%) underwent PCI for stable angina and seventeen patients (29%) for post MI angina procedure success was achieved in all sixty patients without major in hospital complications. No patient had significant side branch closure during the procedure.
- FMD and clinical out come:
During 6 months of follow up twenty four patients had recurrent symptoms of angina(40%) in which seventeen patients(56.6%) in group (1) &the other seven patients in group (2) (23.3%),one patient in group (1) was hospitalized for an acute MI(1.3%)and no reported cases of death was noted in the both groups during the follow up. On the other hand twelve patients in group (1) versus twenty three patients in group (2) remained asymptomatic and without inducible myocardial ischemia.
Six months follow up myocardial perfusion scan revealed positive study in twenty-four patients (40%) of the sixty patients included in the study. Twenty-three patients showed evidence of myocardial ischemia in the revascularized territory .comparing both groups, seventeen patients (57%) had positive perfusion scan(in whom fifteen patients had recurrent anginal attack and two patients were asymptomatic but had positive myocardial perfusion scan) while only seven patients (23%)in group (2) showed evidence of myocardial ischemia (in whom five patients had recurrent anginal attack and two patients were asymptomatic but had positive myocardial perfusion scan).
Patients that had positive clinical out come during their follow up in both groups underwent a repeat coronary angiography, instent restenosis was detected in nineteen patients (31.7%), fifteen of them(50%) in group 1 and the other four (13.3%) in group (2).one patient (3.3%) in group (1), who was hospitalized for AMI showed disease progression on anon-target vessel (Denovo lesion in non-revascularized territory), nine patients (15%)had non-significant CAD without significant (≥50%) instent restenosis.
Again Patients were re vided into 2 groups according to the absence or presence of ISR:
Group A: 19 patients with ISR (31.6%)
Group B: 41 patients with no clinical or spect evidence of ISR (69.4%)
In patients with ISR( group A), fifteen patients were males(79%), the others were females, nearly the half were IDDM, hypertensive and dyslipaedemics. eight patients were smokers (42%)&seven patients gave appositive family history(37%)while all nineteen patients had segmental wall motion abnormalities (SWMA) (100%) and their mean EF were (47.74±5.51%).