Purpose
Type-2 diabetes mellitus (DM)is a well-recognized risk factor (RF) and negative prognostic/predictive factor for coronaryartery disease (CAD) and cardiovascular (CV) events.Autonomic diabeticneuropathy (DN)increases the CV risk in type-2 DM [1-2];Charcot neuroarthropathy (CN)is a severe disease of the foot,
with unknown pathogenesis (neurotraumatic/neurovascular),that often occurs in DN andfurther increases morbidity/mortality risk [3-4].
Screeningfor the early detection of CAD could be useful in thesepatients,
butthe diagnosticapproach of choice anditsclinical/prognostic impact arestillcontroversial [5-7].
Moreover,
the CV implicationsof CN have not yet been fully investigated,
and the accurate assessment/prevention...
Methods and Materials
This was aprospectivesingle-centre observational (case-control)study.
Patients
70asymptomatictype-2 DM patients were enrolled:
34with CN;
36 with DN without CN.
All subjects had aDNdiagnosis according to the standardizedprocedure ofEwing and Clarke [11-12].All CN patients had previous X-rays (and MR in some cases) of both feettaken during the acute phase toconfirm or rule out CNdiagnosis [13].None of the subjects hada history ofulceration,
and the CN group did not include individualsin theacute phase at the moment of study.
All patientsdid not havecardiacsymptoms and showed a normal physical examinationand ECG...
Results
TheCN groupshowedhigher rates ofsignificant coronary stenosis at MDCT-CA in comparisonwith the DN group(p<0.001) (Fig.
2);
No significantdifferencesresultedin CACS between the two groups(p=0.980) (Fig.
3),
nor didCACS distributionfor coronarystenosis ≥or <50%in all subjects(p =0.814),inpatients with CN(p=0.661)or withDN(p=0.559) (Fig.
4);
Thedifferentclasses of CACS (low/mild vs moderate/severe)showed adirect correlation with both the carotid(p=0.001) and the lower limb district CS(p=0.0014);
No significantdifferenceswere foundin the carotid and lower limb district CS distribution betweent the two groups(p=0.575 and 883,
respectively)(Fig.
5).
Our study shows that patients with CN have a higherprevalence...
Conclusion
Our preliminaryresultsdemonstratethatDNincreases CV risk,
andCNsubjects have a highercoronary atherosclerotic plaque burden/CAD,
whichseemsanindependentpredictor of survivalin these patients [24];
To our knowledge,no studies have assessed the role of MDCT in subcategories oftype-2 DMpatientsor demonstrated that CN,
beyond diabeticneuropathy [25],
is associated with more severe coronaryatherosclerosis: this would reopen the discussion on the opportunity toscreen for CAD even asymptomatic diabetic subjects withCN,highlighting that theymight benefit froma more accurate cardiac evaluation;
MDCT-CA may play an importantrole in the CV risk stratification of asymptomatic type-2 DMpatients with DN,
suggesting the...
References
[1]Rathmann W,
Ziegler D,
Jahnke M,
Haastert B,
Gries FA (1993)Mortality in diabetic patients with cardiovascular autonomic neuropathy.Diabet Med 10:820–824
[2]Liao D,
Carnethon M,
Evans GW,
Cascio WE,
Heiss G (2002)Lower heart rate variability is associated with the development ofcoronary heart diseases in individuals with diabetes: theAtherosclerosis Risk in Communities Study.
Diabetes 51:3524–3531
[3]Jeffcoate W,
Lima J,
Nobrega L (2000) The Charcot foot.
DiabetMed 17:253–258
[4]Sohn MW,
Lee TA,
Stuck RM,
Frykberg RG,
Budiman-Mak E(2009) Mortality risk of Charcot arthropathy compared with thatof diabetic foot...