Abstract

The influence of type 2 diabetes, chronic kidney disease, and heart failure on the course of coronary arteries disease individually is sufficiently studied. However, the influence of the combination of these nosologies (cardio-renal-metabolic syndrome) on coronary atherogenesis and the prognosis of myocardial revascularization requires further research.

Methods: To study the relationship of chronic kidney disease with the frequency of various types of coronary heart disease and the long-term prognosis of its in patients with type 2 diabetes.
Materials: The study included 63 patients with coronary heart disease, type 2 diabetes and heart failure with preserved left ventricular ejection fraction who underwent invasive coronary angiography. The participants were divided into 2 groups: 32 patients with an estimated glomerular filtration rate <60 ml/min/1.73 m2 and 31 patients with an estimated glomerular filtration rate ≥60 ml/min/1.73 m2.

Results In 14.3 % of patients with coronary heart disease, type 2 diabetes and heart failure with preserved ejection fraction, there were no significant lesions of the coronary arteries, but the coronary blood flow reserve index was reduced, while in 85.7 % of cases stenosis of coronary vessels that required percutaneous coronary intervention was found. During 5 years of observation in 65.5 % patients after coronary stenting in the presence of chronic kidney disease with a glomerular filtration rate <60 ml/min/1.73 m2 in there was a recurrence of myocardial ischemia mainly due to the appearance of new coronary lesions.

Conclusions: Coronary microvascular dysfunction was the cause of coronary heart disease in patients with type 2 diabetes and heart failure with preserved left ventricular ejection fraction in 14.3 %, while in 85.7 % of cases it was stenosing coronary atherosclerosis. The presence of stage 3A or more severe chronic kidney disease is associated with a higher rate recurrence of coronary heart disease within 5 years after primary percutaneous coronary intervention.

Key words: ischemic heart disease, chronic kidney disease, microvascular angina, percutaneous coronary intervention, cardio-renal-metabolic syndrome

1. Jespersen L., Hvelplund A., Abildstrøm S.Z., Pedersen F., et al. Stable angina pectoris with no obstructive coronary artery disease is associated with increased risks of major adverse cardiovascular events. Eur Heart J. 2012;33(6):734-744. https://doi.org/10.1093/eurheartj/ehr331
2. Kunadian V., Chieffo A., Camici P.G., Berry C., Escaned J., et al. An EAPCI Expert Consensus Document on Ischaemia with Non-Obstructive Coronary Arteries in Collaboration with European Society of Cardiology Working Group on Coronary Pathophysiology & Microcirculation Endorsed by Coronary Vasomotor Disorders International Study Group. Eur Heart J. 2020;41(37):3504-3520. https: //doi.org / 10.1093 / eurheartj / ehaa503
3. Marassi M, Fadini G. The cardio-renal-metabolic connection: a review of the evidence. Cardiovascular Diabetology, 2023,22: 195 https: //doi.org /10.1186/s12933-023-01937-x.
4. JiaQ,ShiS,YuanG,ShiJ,ShiS,etal.Theeffectof nicorandil in patients with cardiac syndrome X: a metaanalysis of randomized controlled trials. Medicine (Baltimore). 2020, 99:e22167. 10.1097/MD.0000000000022167