Kronik Böbrek Hastalığı Olan Tip 2 Diyabetli Hastalarda Aortik Yayılım Hızı ile Subklinik Aterosklerozun Değerlendirilmesi

Year 2016, Volume: 19 Issue: 3, 167 - 172, 01.12.2016

Mehmet Yaman , Türkan Mete İsmail Özer Yasemin Kaya Ahmet Karataş

Abstract

Giriş:
Diabetes mellitus (DM) ve kronik böbrek hastalığı
(KBH) aterosklerozu hızlandırmaktadır. Klinik sonuçları iyileştirmek için,
aterosklerozu değerlendiren ve izleyen invaziv olmayan görüntüleme yöntemleri
geliştirilmektedir. Son zamanlarda, inen torasik aortun renkli M-mod yayılım
hızının [aortik yayılım hızı (AYH)] koroner ve karotisaterosklerozu ile
ilişkili olduğu gösterilmiştir.

Hastalar
ve Yöntem: Çalışma popülasyonu KBH olan
tip 2 diyabetli 90 hasta (grup 1) ve yaş ve cinsiyet benzer, normal böbrek
fonksiyonlarına sahip tip 2 diyabetli 40 hastadan (grup 2) oluşmaktaydı.
Karotis intima-media kalınlığı (KİMK) ve AYH ölçüldü. Bilinen koroner kalp
hastalığı veya son dönem böbrek yetmezliği olan hastalar çalışmaya dahil
edilmedi.

Bulgular:
Grup 2 ile karşılaştırıldığında, grup 1 hastalar
daha düşük AYH düzeylerine (grup 1= 29.85 ± 3.95 cm/sn ve grup 2= 41.05 ± 3.34
cm/s, p< 0.001) ve daha yüksek KİMK düzeylerine (grup 1= 1.06 ± 0.11 mm ve
grup 2= 0.78 ± 0.10 mm, p< 0.001) sahipti. AYH ve KİMK arasında anlamlı
korelasyon mevcuttu (r= -0.669, p< 0.001).

Sonuç:
KBH
olan diyabetli hastalar, normal böbrek fonksiyonlu diyabetli hastalara göre
daha belirgin AYH ve KIMK değerleri ile belirlenen daha fazla subklinik ateroskleroza
sahiptir. Bu basit metodlar, aterosklerozun progresyonunun primer önlenmesi
için hasta seçimini geliştirebilir.

Keywords

Aortik yayılım hızı, karotis intima-media kalınlığı, tip 2 diabetes mellitus, kronik böbrek hastalığı, ateroskleroz

Assessment of Subclinical Atherosclerosis with Aortic Velocity Propagation in Patients with Type 2 Diabetes and Chronic Kidney Disease

Abstract

Introduction:
Diabetes mellitus (DM) and chronic kidney disease
(CKD) accelerate the process of atherosclerosis. To improve clinical outcomes,
non-invasive imaging modalities have been proposed to measure and monitor
atherosclerosis. Recently, colour M-mode-derived propagation velocity of the
descending thoracic aorta [aortic velocity propagation (AVP)] has been shown to
be associated with coronary and carotid atherosclerosis.

Patients
and Methods: The study population included 90 patients
with type 2 diabetes who had CKD (Group 1) and 40 age- and sex-matched patients
with type 2 diabetes who had a normal renal function (Group 2). Carotid
intima-media thickness (CIMT) and AVP were measured. Patients with known
coronary heart disease or end-stage renal disease were excluded.

Results:
Compared with Group 1, patients in Group 2 had
significantly lower AVP (Group 1=  29.85
± 3.95 cm/s and Group 2= 41.05 ± 3.34 cm/s, p< 0.001) and higher CIMT (Group
1= 1.06 ± 0.11 mm and Group 2= 0.78 ± 0.10 mm, p< 0.001). There were
significant correlations between AVP and CIMT (r= -0.669, p< 0.001).

Conclusion:
Patients
with diabetes who have CKD exhibit more subclinical atherosclerosis, which is
determined by more prominent AVP and CMIT, than patients with diabetes who have
a normal renal function. These simple methods might improve patient selection
for the prevention of primary atherosclerotic progression.

Keywords

Aortic velocity propagation, carotid intima-media thickness, type 2 diabetes, chronic kidney disease, atherosclerosis

References

• 1. Grundy SM, Benjamin IJ, Burke GL, Chait A, Eckel RH, Howard BV, et al. Diabetes and cardiovascular disease: a statement for healthcare professionals from the American Heart Association. Circulation 1999;100:1134-46.
• 2. National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. Circulation 2002;106:3143-21.
• 3. De Backer G, Ambrosioni E, Borch-Johnsen K, Brotons C, Cifkova R, Dallongeville J, et al, European Society of Cardiology Committee for Practice Guidelines. European guidelines on cardiovascular disease prevention in clinical practice: third joint task force of European and other societies on cardiovascular disease prevention in clinical practice (constituted by representatives of eight societies and by invited experts). Eur J Cardiovasc Prev Rehabil 2003;10:S1.
• 4. Niakan E, Harati Y, Rolak LA, Comstock JP, Rokey R. Silent myocardial infarction and diabetic cardiovascular autonomic neuropathy. Arch Intern Med 1986;146:2229.
• 5. Sarnak MJ, Levey AS, Schoolwerth AC, Coresh J, Culleton B, Hamm LL, et al; American Heart Association Councils on Kidney in Cardiovascular Disease, High Blood Pressure Research, Clinical Cardiology, and Epidemiology and Prevention. Kidney disease as a risk factor for development of cardiovascular disease: a statement from the American Heart Association Councils on Kidney in Cardiovascular Disease, High Blood Pressure Research, Clinical Cardiology, and Epidemiology and Prevention. Circulation 2003;108:2154.
• 6. London GM, Guerin AP, Marchais SJ, Pannier B, Safar ME, Day M, et al. Cardiac and arterial interactions in end-stage renal disease. Kidney Int 1996;50:600-8.
• 7. Gunes Y, Tuncer M, Guntekin U, Ceylan Y, Simsek H, Sahin M, et al. The relation between the color Mmode propagation velocity of the descending aorta and coronary and carotid atherosclerosis and flow-mediated dilatation. Echocardiography 2010;27:300-5.
• 8. Ognibene A, Grandi G, Lorubbio M, Rapi S, Salvadori B, Terreni A, et al. KDIGO2012 Clinical Practice Guideline CKD classification rules out creatinine clearance 24 hour urine collection? Clin Biochem 2016;49:85-9.
• 9. Stein JH, Korcarz CE, Hurst RT Lonn E, Kendall CB, Mohler ER, et al; American Society of Echocardiography Carotid Intima-Media Thickness Task Force. Use of carotid ultrasound to identify subclinical vascular disease and evaluate cardiovascular disease risk: a consensus statement from the American Society of Echocardiography. Carotid intima-media thickness Task Force Endorsed by the Society for vascular Medicine. J Am SocEchocardiogr 2008;21:93-111.
• 10. London GM, Guerin AP, Marchais SJ, Pannier B, Safar ME, Day M, et al. Cardiac and arterial interactions in end-stage renal disease. Kidney Int 1996;50:600-8.
• 11. Redberg RF, Vogel RA, Criqui MH, Herrington DM, Lima JA, Roman MJ. 34th Bethesda Conference: Task force #3-- What is the spectrum of current and emerging techniques for the noninvasive measurement of atherosclerosis? J Am Coll Cardiol 2003;41:1886-98.
• 12. Greenland P, Abrams J, Aurigemma GP, Bond MG, Clark LT, Criqui MH, et al. Prevention conference V: Beyond secondary prevention; identifying the high-risk patient for primary prevention: noninvasive tests of atherosclerotic burden: Writing Group III. Circulation 2000;101:E16-E22.
• 13. Third report of the National Cholesterol Education Program: Expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III) Þnal report. Circulation 2002;106:3143-421.
• 14. Naghavi M, Falk E, Hecht HS, Jamieson MJ, Kaul S, Berman D, et al; SHAPE Task Force. From vulnerable plaque to vulnerable patient Part III: Executive summary of the Screening for Heart Attack Prevention and Education (SHAPE) Task Force report. Am J Cardiol 2006;98:2H-15H.
• 15. Mancia G, De Backer G, Dominiczak A, Cifkova R, Fagard R, Germano G, et al; 2007 Guidelines for the management of arterial hypertension: The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur Heart J 2007;28: 1462-536.
• 16. Temelkova-Kurktschiev TS, Koehler C, Leonhardt W, Schaper F, Henkel E, Siegert G, et al. Increased intimal-medial thickness in newly detected type 2 diabetes: Risk factors. Diabetes Care 1999;22:333-8.
• 17. Paul J, Dasgupta S, Ghosh MK, Shaw K, Roy KS, Niyogi SM. A study of atherosclerosis in patients with chronic renal failure with special reference to carotid artery intima mediathickness. Heart Views 2012; 13:91-6.
• 18. Nakamura T, Kawagoe Y, Matsuda T, Ueda Y, Shimada N, Ebihara I, et al. Oral ADSORBENT AST-120 decreases carotid intima-media thickness and arterial stiffness in patients with chronic renal failure. Kidney Blood Press Res 2004; 27:121-6.
• 19. Thenappan T, Ali Raza J, Movahed A. Aortic atheromas: Current concepts and controversies a review of the literature. Echocardiography 2008;25:198-207.
• 20. Sezgin AT, Sigirci A, Barutcu I, Topal E, Sezgin N, Ozdemir R, et al. Vascular endothelial function in patients with slow coronary flow. Coron Artery Dis 2003;14:155-61.
• 21. Sahin M, Simsek H, Akyol A, Akdag S, Yaman M, Aydin C, et al. A new echocardiographic parameter of arterial stiffness in end-stage renal disease. Herz 2014;39:749-54.
• 22. Simsek H, Sahin M, Gunes Y, Dogan A, Gumrukcuoglu HA, Tuncer M. A novel echocardiographic method for the detection of subclinical atherosclerosis in newly diagnosed, untreated type 2 diabetes. Echocardiography 2013; 30:644-8.