S-Space College of Medicine/School of Medicine (의과대학/대학원) Dept. of Medicine (의학과) Theses (Ph.D. / Sc.D._의학과)
Identification of the pathophysiology of cardiac microvasculopathy in diabetes mellitus and its effect on the remodeling of coronary arteries
당뇨병성 심근 미세혈관병증 병태생리 규명과 관상동맥 재형성에 미치는 영향
- 의과대학 의학과
- Issue Date
- 서울대학교 대학원
- diabetes mellitus; cardiac microvasculopathy; capillary changes; myocardial perfusion; heart MRI; coronary angiography; optical computer tomography
- 학위논문 (박사)-- 서울대학교 대학원 : 의과대학 의학과, 2018. 2. 김명아.
Diabetes mellitus (DM) causes macro- and microvasculopathy. Data on cardiac microvascular changes in large animals are scarce. We sought to determine the effect of DM on macro- and microvascular changes in diabetic pigs and humans.
Eight domestic pigs (4 with type I DM and 4 controls) underwent coronary angiography with optical coherent tomography (OCT
at baseline and 1 and 2 months), coronary CT angiography (CCTA), cardiac magnet resonance (CMR) imaging, and histologic examination.
The diabetic pigs had more irregular capillaries with acellular capillaries and a smaller capillary diameter (11.7±0.33㎛ vs. 13.5±0.53㎛, P<0.001) than those of the control pigs. The OCT showed no significant epicardial stenosis in either group
however diabetic pigs had a greater intima-media thickness. CMR results showed that diabetic pigs had a lower relative upslope at rest (31.3±5.9 vs. 37.9±8.1, P = 0.011) and during stress (18.0±3.0 vs. 21.6±2.8, P = 0.007) than the control pigs, implying decreased myocardial perfusion.
Among the 79 patients with ST elevation myocardial infarction, 25 had DM and they had lower myocardial perfusion on CMR as well.
DM causes increase in intima-media thickness and microvascular remodeling leading to a decrease in myocardial perfusion in large animals at a very early stage of the disease course. Early and effective interventions are necessary to interrupt the progression of vascular complications in diabetic patients.