Vedat Bakuy1, Orcun Unal2, Mete Gursoy2, Aysegul Kunt3, Kanat Ozisik4, Mustafa Sargon5, Mustafa Emir3, Erol Sener3. 1. Department of Cardiovascular Surgery, Bakirkoy Dr Sadi Konuk Training and Research Hospital, Istanbul, Turkey. Electronic address: vedatbakuy@yahoo.com. 2. Department of Cardiovascular Surgery, Bakirkoy Dr Sadi Konuk Training and Research Hospital, Istanbul, Turkey. 3. Department of Cardiovascular Surgery, Ataturk Training and Research Hospital, Ankara, Turkey. 4. Department of Cardiovascular Surgery, 29 Mayis Hospital, Ankara, Turkey. 5. Department of Anatomy, Faculty of Medicine, University of Hacettepe, Ankara, Turkey.
Abstract
BACKGROUND: Diabetes is a well- identified major risk factor for cardiovascular diseases. This study was performed to evaluate the effect of diabetes and impact of glycemic control on internal thoracic artery (ITA) morphology by electron microscopy. METHODS: Thirty patients scheduled for coronary artery bypass grafting were enrolled in this study. Samples of ITA were taken during the surgery for electron microscopic evaluation. Group I (n = 10) consisted of diabetics who have poor glycemic control (HbA1c > 7.5%), group II (n = 10) of well-regulated (HbA1c = 4.4% to 6.2%) diabetic patients, and group III (n = 10) of nondiabetic patients. Samples were prepared as ultrathin sections and an original semiquantitative method of scoring was applied to describe the morphologic changes of endothelium. Final scores were analyzed with analysis of variance and post hoc analysis. RESULTS: In group I large vacuoles, swollen mitochondria were seen in endothelial cells and subendothelial edema was prominent. Endothelia (2.5 ± 1.2), arterial wall (2.0 ± 0.0), and endothelial mitochondria (2.9 ± 1.3) scores of group I were significantly higher than the other 2 groups (p < 0.001). The samples of group II and group III did not show significant differences with each other. The correlation between HbA1c values and total endothelial scores statistically significant (r = 0.912; p < 0.001). CONCLUSIONS: There is a correlation between HbA1c values and morphologic changes of ITA graft. Uncontrolled diabetes is an important predictor of morphologic changes evidenced by the ultrastructural findings. These ultrastructural changes were not as prominent in the diabetes mellitus patients with well controlled metabolic statuses and patients without diabetes.
BACKGROUND:Diabetes is a well- identified major risk factor for cardiovascular diseases. This study was performed to evaluate the effect of diabetes and impact of glycemic control on internal thoracic artery (ITA) morphology by electron microscopy. METHODS: Thirty patients scheduled for coronary artery bypass grafting were enrolled in this study. Samples of ITA were taken during the surgery for electron microscopic evaluation. Group I (n = 10) consisted of diabetics who have poor glycemic control (HbA1c > 7.5%), group II (n = 10) of well-regulated (HbA1c = 4.4% to 6.2%) diabeticpatients, and group III (n = 10) of nondiabeticpatients. Samples were prepared as ultrathin sections and an original semiquantitative method of scoring was applied to describe the morphologic changes of endothelium. Final scores were analyzed with analysis of variance and post hoc analysis. RESULTS: In group I large vacuoles, swollen mitochondria were seen in endothelial cells and subendothelial edema was prominent. Endothelia (2.5 ± 1.2), arterial wall (2.0 ± 0.0), and endothelial mitochondria (2.9 ± 1.3) scores of group I were significantly higher than the other 2 groups (p < 0.001). The samples of group II and group III did not show significant differences with each other. The correlation between HbA1c values and total endothelial scores statistically significant (r = 0.912; p < 0.001). CONCLUSIONS: There is a correlation between HbA1c values and morphologic changes of ITA graft. Uncontrolled diabetes is an important predictor of morphologic changes evidenced by the ultrastructural findings. These ultrastructural changes were not as prominent in the diabetes mellituspatients with well controlled metabolic statuses and patients without diabetes.
Authors: Andrea Mario Bolla; Cristian Loretelli; Laura Montefusco; Giovanna Finzi; Reza Abdi; Moufida Ben Nasr; Maria Elena Lunati; Ida Pastore; Joseph V Bonventre; Manuela Nebuloni; Stefano Rusconi; Pierachille Santus; Gianvincenzo Zuccotti; Massimo Galli; Francesca D'Addio; Paolo Fiorina Journal: Diabetes Metab Res Rev Date: 2022-07-22 Impact factor: 8.128