The Influence of Carbohydrate Metabolism Disorders on the Course of Perioperative Period in Cardiac Surgery Patients with Post-Infarction Left Ventricular Aneurysms

Keywords: cardiodiabetology, risk stratification, impaired glucose tolerance, artificial blood circulation, surgical myo-cardial revascularization, type 2 diabetes mellitus, chronic coronary syndrome, complicated form of coronary artery disease, inhibitor of sodium-dependent glucose cotransporter type 2

Abstract

The aim. To study the impact of carbohydrate metabolism disorders on perioperative period in cardiac surgery pa-tients with post-infarction left ventricular (LV) aneurysms.

Materials and methods. Retrospective analysis of perioperative period in random 132 patients with post-infarction LV aneurysms of various locations, who were operated on and discharged from the department of surgical treatment of ischemic heart disease of the National Amosov Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine. Disorders of carbohydrate metabolism (DCM) were detected in 98 (74.2%) patients, among whom type 2 diabetes mellitus (DM) was diagnosed in 34 (25.7%) patients, impaired glucose tolerance (IGT) in 64 (48.5%). All the patients underwent general clinical examination, electrocardiography, echocardiography, coronary angiography and surgical treatment.

Results. When analyzing the clinical picture in patients with post-infarction LV aneurysms, painless myocardial isch-emia was diagnosed in 41 (31.06%) patients, among whom type 2 DM in 11 (26.8%) cases and IGT in 18 (43.9%). No statistically significant difference was found in patients with and without DCM in the LV contractile function, presence of LV thrombosis, atrial fibrillation, chronic kidney disease, stenosis of brachiocephalic arteries and arteries of the lower extremities, gouty arthritis, and body weight. Intraoperatively, diameter of the coronary arteries in patients with type 2 DM was slightly smaller compared to patients without DCM. Its increase in cases of calcification of coronary arteries and aorta among patients of the study group with DCM was statistically insignificant. A careful analysis of the postoperative period in patients with and without DCM showed a statistically significant occurrence of paroxysms of atrial fibrillation in 30 (90.9%) and 3 (9.1%) cases, respectively (p=0.0115). The patients with DCM had longer stay in the intensive care unit: 4.03 ± 2.3 vs. 3.2 ± 1.3 days (p=0.0483). Acute kidney injury in the early postoperative period occurred in 8 (6.06%) patients, including 5 (62.5%) with type 2 DM (p=0.0142). Sternal wound infection occurred in 2 (1.5%) patients with type 2 DM (p=0.0156).

Conclusions. Among cardiac surgical patients with postinfarction LV aneurysms, the major part is formed by patients with DCM (74.2%), the presence of which complicates the course of the postoperative period with the development of paroxysms of atrial fibrillation (p=0.0115), acute kidney injury (p=0.0142), sternal wound infection (p=0.0156), a long stay in the intensive care unit (p=0.0483).

References

  1. Aboyans V, Cosentino F. Cardio-diabetology: The new ‘sweetheart’ in cardiovascular prevention. Eur J Prev Cardiol. 2019;26(2_suppl):5-6. https://doi.org/10.1177/2047487319887483
  2. Prattichizzo F, La Sala L, Rydén L, Marx N, Ferrini M, Valensi P, et al. Glucose-lowering therapies in patients with type 2 diabetes and cardiovascular diseases. Eur J Prev Cardiol. 2019;26(2_suppl):73-80. https://doi.org/10.1177/2047487319880040
  3. Beulens J, Rutters F, Rydén L, Schnell O, Mellbin L, Hart HE, et al. Risk and management of pre-diabetes. Eur J Prev Cardiol. 2019;26(2_suppl):47-54. https://doi.org/10.1177/2047487319880041
  4. Cosentino F, Grant PJ, Aboyans V, Bailey CJ, Ceriello A, Delgado V, et al.; ESC Scientific Document Group. 2019 ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD. Eur Heart J. 2020;41(2):255-323. https://doi.org/10.1093/eurheartj/ehz486
  5. Hansen D, Kraenkel N, Kemps H, Wilhelm M, Abreu A, Pfeiffer AF, et al. Management of patients with type 2 diabetes in cardiovascular rehabilitation. Eur J Prev Cardiol. 2019;26(2_suppl):133-144. https://doi.org/10.1177/2047487319882820
  6. Dal Canto E, Ceriello A, Rydén L, Ferrini M, Hansen TB, Schnell O, et al. Diabetes as a cardiovascular risk factor: An overview of global trends of macro and micro vascular complications. Eur J Prev Cardiol. 2019;26(2_suppl):25-32. https://doi.org/10.1177/2047487319878371
  7. La Sala L, Prattichizzo F, Ceriello A. The link between diabetes and atherosclerosis. Eur J Prev Cardiol. 2019;26(2_suppl):15-24. https://doi.org/10.1177/2047487319878373
  8. Gogayeva OK, Rudenko AV, Lazoryshynets VV, Dzakhoieva LS. [Analysis of the endocrine status of patients with coronary artery disease in cardiac surgery]. Ukrainian Journal of Cardiology. 2021;28(1):26-33. Ukrainian. https://doi.org/10.31928/1608-635X-2021.1.2633
  9. Shah AD, Langenberg C, Rapsomaniki E, Denaxas S, Pujades-Rodriguez M, Gale CP, et al. Type 2 diabetes and incidence of cardiovascular diseases: a cohort study in 1·9 million people. Lancet Diabetes Endocrinol. 2015;3(2):105-113. https://doi.org/10.1016/S2213-8587(14)70219-0
  10. Almeda FQ, Kason TT, Nathan S, Kavinsky CJ. Silent myocardial ischemia: concepts and controversies. Am J Med. 2004;116(2):112-118. https://doi.org/10.1016/j.amjmed.2003.09.029
  11. Barthelemy O, Le Feuvre C, Timsit J. Silent myocardial ischemia screening in patients with diabetes mellitus. Arq Bras Endocrinol Metabol. 2007;51(2):285-293. https://doi.org/10.1590/s0004-27302007000200018
  12. Valensi P, Meune C. Congestive heart failure caused by silent ischemia and silent myocardial infarction : Diagnostic challenge in type 2 diabetes. Herz. 2019;44(3):210-217. https://doi.org/10.1007/s00059-019-4798-3
  13. Meyer P. Dépister la maladie coronarienne chez le sujet diabétique asymptomatique: oui, mais... [Silent myocardial ischemia in diabetic patients: to screen or not to screen?]. Rev Med Suisse. 2005;1(22):1505-1507, 1509-1510. French.
  14. Abdelnabi M, Saleh Y, Almaghraby A. Incidentally discovered left ventricular true aneurysm and ventricular septal rupture after silent myocardial infarction in an elderly diabetic patient. BMJ Case Rep. 2022 Apr 12;15(4):e250046. https://doi.org/10.1136/bcr-2022-250046
  15. Antunes MJ, Antunes PE. Left-ventricular aneurysms: from disease o repair. Expert Rev Cardiovasc Ther. 2005;3(2):285-294. https://doi.org/10.1586/14779072.3.2.285
  16. Sui Y, Teng S, Qian J, Zhao Z, Zhang Q, Wu Y. Treatment outcomes and therapeutic evaluations of patients with left ventricular aneurysm. J Int Med Res. 2019;47(1):244-251. https://doi.org/10.1177/0300060518800127
  17. Zioło J, Ramotowski B, Zaborska B, Wojdyga R, Miśko J, Budaj A. Left ventricular aneurysm: Truths and falsehoods. Kardiol Pol. 2023;81(3):308-309. https://doi.org/10.33963/KP.a2022.0293
  18. Gensler D, Müntze J, Nordbeck P. Long-term outcome after surgical repair of a rapid-grown ischemic ventricular aneurysm causing ventricular tachycardia. Clin Case Rep. 2019;7(3):413-415. https://doi.org/10.1002/ccr3.1940
  19. Ruzza A, Czer LSC, Arabia F, Vespignani R, Esmailian F, Cheng W, et al. Left Ventricular Reconstruction for Postinfarction Left Ventricular Aneurysm: Review of Surgical Techniques. Tex Heart Inst J. 2017;44(5):326-335. https://doi.org/10.14503/THIJ-16-6068
  20. Marx N, Federici M, Schütt K, Müller-Wieland D, Ajjan RA, Antunes MJ, et al.; ESC Scientific Document Group. 2023 ESC Guidelines for the management of cardiovascular disease in patients with diabetes. Eur Heart J. 2023;44(39):4043-4140. https://doi.org/10.1093/eurheartj/ehad192
  21. Ndumele CE, Rangaswami J, Chow SL, Neeland IJ, Tuttle KR, Khan SS, et al.; American Heart Association. Cardiovascular-Kidney-Metabolic Health: A Presidential Advisory From the American Heart Association. Circulation. 2023;148(20):1606-1635. https://doi.org/10.1161/CIR.0000000000001184
Published
2023-12-28
How to Cite
Gogayeva, O. K. (2023). The Influence of Carbohydrate Metabolism Disorders on the Course of Perioperative Period in Cardiac Surgery Patients with Post-Infarction Left Ventricular Aneurysms. Ukrainian Journal of Cardiovascular Surgery, 31(4), 20-25. https://doi.org/10.30702/ujcvs/23.31(04)/G062-2025

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