STRUCTURAL AND FUNCTIONAL STATE OF THE HEART AND CORONARY BLOOD FLOW IN PATIENTS WITH TYPE 2 DIABETES WITH NEPHROPATHY

THE AIM. To assess changes in coronary blood flow and the structural and functional features of heart disease in diabetic patients with different stages of diabetic nephropathy (DN). PATIENTS AND METHODS. It was investigated 142 patients with type 2 diabetes. The diagnosis of diabetic nephropathy was established with the help of quantitative evaluation method of albumin in the first morning urine (three times).Survey methods included transthoracic echocardiography, single photon emission computed tomography (SPECT) at rest and with pharmacological stress ATP, bicycle ergometry, ECG monitoring. RESULTS. It was found that the thickness of the left ventricle in patients with DN, higher than that in patients without DN. The progression of DN was associated with an increase in left ventricular mass (LVMM) and LVMM index, end systolic and end diastolic volume, decreased left ventricular ejection fraction. It was shown a reduction in absolute parameters of transmitral flow in combination with an increase in the index E/A in patients with microalbuminuria and pseudonormalization specified rate in patients with proteinuria. In patients with proteinuria during cycle ergometry were more prevalent ischemic myocardial changes, but according to pharmacological stress SPECT revealed no deterioration in coronary perfusion compared with the rest in either group. CONCLUSION. Microalbuminuric stage of diabetic nephropathy is characterized by myocardial hypertrophy and diastolic left ventricular dysfunction, reduced systolic function at the intellectual and emotional stress. Proteinuric stage of diabetic nephropathy is associated with myocardial hypertrophy and diastolic left ventricular dysfunction, reduced global myocardial
contractility at rest, a significant deterioration in coronary blood flow. Leading role in reducing coronary blood flow with the progression of diabetic nephropathy is microvascular ischemia.

Type 2 diabetes mellitus, diabetic nephropathy, echocardiography, myocardial scintigraphy, bicycle ergometry, ECG monitoring

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