Abstract
Background: Diabetic patients have been reported to have impaired coronary collateral vessel growth, although they have excessive neovascularization in the retina.
Hypothesis: This study was designed to compare coronary collateral circulation (CCC) in patients with proliferative diabetic retinopathy (PDR) with that in patients without DR.
Methods: Ninety diabetic patients with chronic total occlusion in at least one major epicardial coronary artery were enrolled in the study. Groups 1 and 2 consisted of 48 patients without DR and 42 patients with PDR, respectively. Coronary collateral circulation (CCC) was analyzed according to the Rentrop system. Each group was also divided into two subgroups according to poor and good CCC. Serum vascular endothelial growth factor (VEGF) levels were measured using the enzyme‐linked immunosorbent assay (ELISA) kit.
Results: The mean Rentrop collateral score was higher in Group 1 than in Group 2 (2.39 ± 1.07 vs. 1.76 ± 0.76, respectively, p < 0.001). When the two groups were compared with respect to poor and good CCC, poor CCC was higher in patients with PDR (64 vs. 36%, respectively, p = 0.01). Serum VEGF levels were higher in patients with PDR than in those without DR (219 ± 99 vs. 139 ± 98 pg/ml, p < 0.001); however, patients with poor and good CCC had similar VEGF levels.
Conclusions: We have shown that patients with PDR have a lower coronary collateral score than patients without DR. Also, serum VEGF was significantly higher in patients with PDR than in those without DR. These findings have suggested that diabetes mellitus may have a different action on retinal and coronary circulation.
Keywords: diabetes mellitus, diabetic retinopathy, coronary collateral vessels, vascular endothelial growth factor
Full Text
The Full Text of this article is available as a PDF (30.5 KB).
References
- 1. Abaci A, Oguzhan A, Kahraman S, Eryol NK, Unal S, Arinc H, Ergin A: Effect of diabetes mellitus on formation of coronary collateral vessels. Circulation 1999; 99: 2239–2242 [DOI] [PubMed] [Google Scholar]
- 2. Shah KB, Han DP: Proliferative diabetic retinopathy. Int Ophthalmol Clin 2004; 44: 69–84 [DOI] [PubMed] [Google Scholar]
- 3. Duh E, Aiello LP: Vascular endothelial growth factor and diabetes: The agonist versus antagonist paradox. Diabetes 1999; 48: 1899–1906 [DOI] [PubMed] [Google Scholar]
- 4. Chou E, Suzuma I, Way KJ, Opland D, Clermont AC, Naruse K, Suzuma K, Bowling NL, Vlahos CJ, Aiello LP, King GL: Decreased cardiac expression of vascular endothelial growth factor and its receptors in insulin‐resistant and diabetic states. Circulation 2002; 105: 373–379 [DOI] [PubMed] [Google Scholar]
- 5. The Expert Committee on the Diagnosis and Classification of Diabetes Mellitus : Report of the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Diabetes Care 1997; 20: 1183–1197 [DOI] [PubMed] [Google Scholar]
- 6. Rentrop KP, Cohen M, Blanke H, Phillips RA: Changes in collateral channel filling immediately after controlled coronary artery occlusion by an angioplasty balloon inhuman subjects. J Am Coll Cardiol 1985; 5: 587–592 [DOI] [PubMed] [Google Scholar]
- 7. Matthews DR, Hosker JP, Rudenski AS, Naylor BA, Treacher DF, Turner RC: Homeostasis model assessment: Insulin resistance and beta‐cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia 1985; 28: 412–419 [DOI] [PubMed] [Google Scholar]
- 8. Early Treatment Diabetic Retinopathy Study Research Group : Fundus photographic risk factors for progression of diabetic retinopathy: ETDRS report number 12. Opthalmology 1991; 98 (suppl): 823–833 [PubMed] [Google Scholar]
- 9. Watanabe D, Suzuma K, Suzuma I, Ohashi H, Ojima T, Kurimoto M, Murakami T, Kimura T, Takagi H: Vitreous levels of angiopoietin 2 and vascular endothelial growth factor in patients with proliferative diabetic retinopathy. Am J Ophthalmol 2005; 139: 476–481 [DOI] [PubMed] [Google Scholar]
- 10. Sasayama S, Fujita M: Recent insights into coronary collateral circulation. Circulation 1992; 85: 1197–1204 [DOI] [PubMed] [Google Scholar]
- 11. Carmeliet P: Mechanisms of angiogenesis and arteriogenesis. Nat Med 2000; 6: 389–395 [DOI] [PubMed] [Google Scholar]
- 12. van Royen N, Piek JJ, Buschmann I, Hoefer I, Voskuil M, Schaper W: Stimulation of arteriogenesis: A new concept for the treatment of arterial occlusive disease. Cardiovasc Res 2001; 49: 543–553 [DOI] [PubMed] [Google Scholar]
- 13. Schultz A, Lavie L, Hochberg I, Beyar R, Stone T, Skorecki K, Lavie P, Roguin A, Levy AP: Interindividual heterogeneity in the hypoxic regulation of VEGF. Circulation 1999; 100: 547–552 [DOI] [PubMed] [Google Scholar]
- 14. Conway EM, Collen D, Carmeliet P: Molecular mechanisms of blood vessel growth. Cardiovasc Res 2001; 49: 507–521 [DOI] [PubMed] [Google Scholar]
- 15. Miele C, Rochford JJ, Filippa N, Giorgetti‐Peraldi S, Van Obberghen E: Insulin and insulin‐like growth factor‐I induce vascular endothelial growth factor mRNA expression via different signaling pathways. J Biol Chem 2000; 275: 21695–21702 [DOI] [PubMed] [Google Scholar]
- 16. Waltenberger J, Lange J, Kranz A: Vascular endothelial growth factor‐A‐induced chemotaxis of monocytes is attenuated in patients with diabetes mellitus. Circulation 2000; 102: 185–190 [DOI] [PubMed] [Google Scholar]
- 17. Waltenberger J: Impaired collateral vessel development in diabetes: Potential cellular mechanisms and therapeutic implications. Cardiovasc Res 2001; 49: 554–560 [DOI] [PubMed] [Google Scholar]
- 18. Ritchie JL, Bateman TM, Bonow RO, Crawford MH, Gibbons RJ, Hall RJ, O'Rourke RA, Parisi AF, Verani MS: Guidelines for clinical use of cardiac radionuclide imaging: A report of the ACC/AHA Task Force on assessment of diagnostic and therapeutic cardiovascular procedures. J Nucl Cardiol 1995; 2: 172–192 [DOI] [PubMed] [Google Scholar]
- 19. Tesfamariam B, Brown ML, Deykin D, Cohen RA: Elevated glucose promotes generation of endothelium‐derived vasoconstrictor prostanoids in rabbit aorta. J Clin Invest 1990; 85: 929–932 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 20. Turhan H, Erbay AR, Yasar AS, Bicer A, Sasmaz H, Yetkin E: Impaired coronary blood flow in patients with metabolic syndrome: Documented by thrombolysis in myocardial infarction frame count method. Am Heart J 2004; 148: 789–794 [DOI] [PubMed] [Google Scholar]
- 21. Ono T, Kobayashi J, Sasako Y, Bando K, Tagusari O, Niwaya K, Imanaka H, Nakatani T, Kitamura S: The impact of diabetic retinopathy on long‐term outcome following coronary artery bypass graft surgery. J Am Coll Cardiol 2002; 40: 428–436 [DOI] [PubMed] [Google Scholar]
- 22. Dickson TJ, Gurudutt V, Nguyen AQ, Kumfer K, Maxted W, Brown J, Mahomed Y, Sharp T, Aufiero TX, Fineberg N, March KL: Establishment of a clinically correlated human pericardial fluid bank: Evaluation of intrapericardial diagnostic potential. Clin Cardiol 1999; 22 (1 suppl 1): 140–142 [DOI] [PMC free article] [PubMed] [Google Scholar]