Download Metabolic syndrome and prognosis of ischemic mitral insufficiency

Impact of metabolic syndrome on incidence and prognosis of ischemic mitral insufficiency in the
selected group of patients with coronary artery disease
A Nikolić 1, 2, D Nikolić 1, 3, V Stanimirović 4 , D Micić 1, 5
Medicinski fakultet, Univerzitet u Beogradu, Srbija, 2Institut za kardiovaskularne bolesti - Dedinje, 3Kliničko-bolnički
centar Bežanijska Kosa, 4Agencija za lekove i medicinska sredstva Srbije, 5Klinika za Endokrinologiju KCS
1
Introduction: Myocardial ischemia changes geometry of the heart and leads to mitral insufficiency (MI).
Physicians had to deal with the question of whether the metabolic syndrome (MetSy) had some impact on
MI in terms of prognosis after revascularization. Publications relating to the incidence of ischemic MI in
MetSy patients are insignificant.
Methodology: MetSy is defined by International Diabetes Foundation criteria. MI is graded from 1+ to 4+,
as mild (group I ≤ 1+), moderately severe (group II> ≤ 1+ and 2+) and severe MI (group III ≥ 3+).
Coronary artery disease (CAD) is graded in relation to the number of vessels wich were significant as
stenostic (one, two, three, four and multi-vessel CAD). Patients underwent surgical (coronary artery
baypass grafting (CABG)) and percutaneous revascularization (percutaneus coronary intervention (PCI)).
The incidence of MACE was assessed (major adverse cardiac events), which included myocardial
infarction, angina, and acute heart failure, in the follow-up period of one month after revascularization.
Results: The study included 140 consecutive patients, 88pts. in PCI and 52pts. in ACB group. There were
no significant differences in the frequency of MetSy between groups (p=0.926). Group I is the most
common in the youngest patients group (≤50 years), group II in those older then 65years, while group III
was equally distributed among all patients (chi-square=12.46, df=4, p<0.05). In relation to gender,
differences were not significant (p=0884). Group I was the most common regardless of the number of
affected coronary arteries, group II in two-and three-vessel diseases, and group III in the three-vessel
disease (chi-square=16.27, df=8, p=0.04). Patients without MI had more MACE during follow up (chisquare=8.2, df=3, p=0.042). MetSy had no effect on MI (p=0257) and had a marginal significance
(p=0.086) on the incidence of MACE during follow up.
Conclusion: MI is especially common in older adults with a severe degree of CAD. MetSy had no effect on
the remodeling of the heart, which would cause significant MI. MetSy in patients with MI had a marginal
significance in the incidence of MACE regardless of the type of revascularization.