الفهرس 
DM & Coronary HeartOnly 14 pages are availabe for public view
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Abstract
Heart disease, particularly coronary heart disease (CHD) is a major cause of morbidity and mortality among patients with diabetes mellitus. Morbidity, mortality and re-infarction rate are higher following AMI in diabetic than non-diabetic subjects, with one-year mortality in this population as high as 50%.
Transient ischemic episodes occurred 24 h before AMI have cardio protective effects against subsequent ischemia, which is called ischemic preconditioning with less infarct size and better systolic function.
Ischemic preconditioning is mediated by activation of the KATP channel. It has been reported that the nature of the KATP channel is altered in diabetic hearts and ischemic preconditioning is lost in the presence of diabetes.
The current study aimed to study the value of HbA1c as an indicator of preconditioning in acute myocardial infarction through:
1. Study the effect of DM on preconditioning in AMI.
2. Study the benefit of controlling DM in preserving preconditioning.
The study included 68 patients with the following criteria:
• Presented by acute myocardial infarction for the first time.
• Episodes of chest pain within 24 hours before the attack AMI.
• All patients reperfused within 12 hours of onset of chest pain.
All the patients were subjected to the following: Thorough history, clinical examination and the following investigations: ECG, serial cardiac enzymes, HbA1c and echocardiography to assess the EF %.
Then patients were divided into three groups:
1-Group I: include 30 of non-diabetic patients with normal serum level of HbA1c < 7%
2-Group II: include 8 of well controlled diabetic patients with serum level of HbA1c less than 7%.
3-Group III: include 30 of uncontrolled diabetic patients with elevated serum level of HbA1c more than 7%.
A comparison was done between the three groups by evaluating the outcome of AMI through: the mean peak CK and the mean EF% of each group. All data was gathered, tabulated, and statistically analyzed.
It was noted that there was a difference in the outcome of the left ventricular systolic function after MI among the three groups. In group (I), the non-diabetic patients had a mean EF % of 52.7%. In group (II), the controlled diabetic patients had a mean EF % of 50 %, while the group (III) that represented the diabetic patients with poor control of their blood sugar had the worst outcome with a mean EF % of 44%.
Also, there was a difference in the peak CK value among the three groups. In group (I) the mean peak CK value was 2310.17 IU/l. In group (II) the mean peak CK was 2544.25 IU/l. In group (III) the mean peak CK was 3411.9 IU/l which means that there was more damage in the myocardium in these patients with poor control of their diabetes.
The outcome of LV systolic function is more deteriorated with each increase in the HbA1c above 7 %. At HbA1c (4 -4.9 %), the mean EF % was 56 %, while at HbA1c (>10 %) the mean EF% was 44.1 %.
Also, the more the increase in the HbA1c, the more the increase in the mean peak CK which means more damage in the myocardial muscle. At HbA1c (4 – 4.9 %), the mean peak CK was 2066.27 IU/l, while at HbA1c (> 10 %), the mean peak CK was 3312.33 IU/l.
from this study, we concluded that Ischemic preconditioning is lost in diabetic patients with poor control of their blood sugar and diabetic patients with good control of their blood sugar still keep the favor of the preconditioning.
So, HbA1c can be used as an indicator of ischemic preconditioning in AMI to expect the outcome.