BACKGROUND It is increasingly common to find patients affected by a combination of type 2 diabetes mellitus(T2DM)and coronary artery disease(CAD),and studies are able to correlate their relationships with available bi...BACKGROUND It is increasingly common to find patients affected by a combination of type 2 diabetes mellitus(T2DM)and coronary artery disease(CAD),and studies are able to correlate their relationships with available biological and clinical evidence.The aim of the current study was to apply association rule mining(ARM)to discover whether there are consistent patterns of clinical features relevant to these diseases.ARM leverages clinical and laboratory data to the meaningful patterns for diabetic CAD by harnessing the power help of data-driven algorithms to optimise the decision-making in patient care.AIM To reinforce the evidence of the T2DM-CAD interplay and demonstrate the ability of ARM to provide new insights into multivariate pattern discovery.METHODS This cross-sectional study was conducted at the Department of Biochemistry in a specialized tertiary care centre in Delhi,involving a total of 300 consented subjects categorized into three groups:CAD with diabetes,CAD without diabetes,and healthy controls,with 100 subjects in each group.The participants were enrolled from the Cardiology IPD&OPD for the sample collection.The study employed ARM technique to extract the meaningful patterns and relationships from the clinical data with its original value.RESULTS The clinical dataset comprised 35 attributes from enrolled subjects.The analysis produced rules with a maximum branching factor of 4 and a rule length of 5,necessitating a 1%probability increase for enhancement.Prominent patterns emerged,highlighting strong links between health indicators and diabetes likelihood,particularly elevated HbA1C and random blood sugar levels.The ARM technique identified individuals with a random blood sugar level>175 and HbA1C>6.6 are likely in the“CAD-with-diabetes”group,offering valuable insights into health indicators and influencing factors on disease outcomes.CONCLUSION The application of this method holds promise for healthcare practitioners to offer valuable insights for enhancing patient treatment targeting specific subtypes of CAD with diabetes.Implying artificial intelligence techniques with medical data,we have shown the potential for personalized healthcare and the development of user-friendly applications aimed at improving cardiovascular health outcomes for this high-risk population to optimise the decision-making in patient care.展开更多
Background: Diabetes mellitus (DM) is independently associated with an increased risk of cardiovascular mortality and morbidity, including coronary artery disease (CAD). CAD is a shared burden disease and the leading ...Background: Diabetes mellitus (DM) is independently associated with an increased risk of cardiovascular mortality and morbidity, including coronary artery disease (CAD). CAD is a shared burden disease and the leading cause of death in developed and developing countries. We aimed to assess the angiographic patterns of coronary arteries in patients with DM in a developing country (Yemen) as the first study. Methods: This study is a cross-sectional, prospective, observational study that includes a total of 250 patients who were admitted for elective diagnostic coronary angiography. Results: 96 (38.4%) patients were diabetics;68% were male;mean age was 57 ± 11 years. The incidence of three-vessel disease was 31.2% of patients. Considering the severity of lumen occlusion, (11.2%) of patients had non-significant lesions, (37.6%) of patients had significant lesions, and (32%) had total occlusive lesions. Lesions were of LAD in 76%, RCA in 60%, and LCX in 52% of the population. Among diabetics, two and 3-vessel diseases (33.3% vs. 20.8% & 50% vs. 19.5%, P = 0.001), left main lesion (10.4% vs. 2.6%, P = 0.012), significant stenosis (41.7% vs. 35.1%, P = 0.032), total occlusion of coronary arteries (43.8% vs. 19.5%, P = 0.032) and type C lesion (66.7% vs. 35.1%, P = 0.010) were more frequent than non-DM patients. Conclusion: The burden of significant and severe coronary lesions is more common among DM, which may be the major cause of morbidity and mortality of DM in developing countries.展开更多
Objectives To study clini- cal and coronary angiographic findings in patients with both coronary heart diseases (CHD) and type 2 diabe- tes mellitus (T2DM). Methods 215 patients with CHD confirmed by coronary angiogra...Objectives To study clini- cal and coronary angiographic findings in patients with both coronary heart diseases (CHD) and type 2 diabe- tes mellitus (T2DM). Methods 215 patients with CHD confirmed by coronary angiography were involved in this study. The patients were divided into two groups: 74 CHD patients with T2DM (mean age 64.7 ± 8.2 years, male/female 47/27), and 141 CHD pa- tients without T2DM ( mean age 66. 2 ±9. 2 years, male/female 100/41 ). The clinical features and the data from selective coronary angiographies were com- pared between type 2 diabetic and non - diabetic CHD patients. Results Compared to non - diabetic CHD patients, the patients with both CHD and T2DM suf- fered more from acute myocardial infarction, silent is- chemia and severe arrhythmias ( P < 0. 01, P < 0. 05 ) , and had higher serum triglycerides and apo - lipoprotein B, along with increased serum uric acid (P < 0. 01, P < 0.05), increased left ventricular end diastolic diameter ( P < 0. 01 ) , and decreased left ventricular ejection fraction ( P < 0. 001 ). Compared to non - diabetic CHD patients, the patients with both CHD and T2DM suffered more from triple vessel disease (P < 0. 01) , severe coronary artery stenosis, complete occlusions and diffuse lesions ( P < 0. 001). Conclusions Se- vere clinical manifestation, left ventricular dysfunction, diffuse or complicated lesions of coronary arteries weremore common in patients with both CHD and T2DM, it suggests that the type 2 diabetic CHD patients have poor prognosis.展开更多
OBJECTIVE: To study the protective effects of Dongchongxiacao(Cordyceps)(DCXC) on contrast-induced nephropathy(CIN) in patients with type 2 diabetes and renal insufficiency undergoing coronary angiography.METHODS: A t...OBJECTIVE: To study the protective effects of Dongchongxiacao(Cordyceps)(DCXC) on contrast-induced nephropathy(CIN) in patients with type 2 diabetes and renal insufficiency undergoing coronary angiography.METHODS: A total of 120 patients with type 2 diabetes whose estimated glomerular filtration rate(e GFR) was ≤ 60 m L/minee grou·1.73 m2,were divided randomly into thrps,basic treatment group(n = 41),standard DCXC therapy group(n = 39,2-g corbrin capsules,3 times/d,3 days before and after angiography),and intensive DCXC therapy group(n = 40,3-g corbrin capsules,3 times/d,3 days before and after angiography). Serum creatinine(Scr)and e GFR were assessed at the time of admission to hospital,and on days 1,2 and 3 after angiography. Urine neutrophil-gelatinase-associated-lipocalin(NGAL),kidney injury molecule-1(KIM-1) and interleukin-18(IL-18) were measured before angiography and at day 1 after angiography for all patients. The primary end point was the prevalence of CIN. The secondary end point was a 25% or greater reduction in e GFR.RESULTS: CIN occurred in 11 of 120 patients(9.17 %). The prevalence of CIN was lower in the DCXC treatment groups than in the basic treatment group(P < 0.05),with a more significant decrease in the prevalence of CIN in the intensive DCXC therapy group(P < 0.01). Compared with the basic treatment group,a lower proportion of patients in the DCXC treatment groups had an e GFR decrease of 25% or greater(P < 0.05); patients with an e GFR decrease of 25% or greater accounted for an even lower proportion in the intensive DCXC therapy group(P < 0.01). Within 1 day of the procedure,urine levels of KIM-1,NGAL and IL-18 in patients in the intensive DCXC therapy group were lower than those in the basic treatment group and standard therapy group(P < 0.05).CONCLUSION: DCXC treatment may protect against CIN in patients with type 2 diabetes and renal insufficiency undergoing coronary angiography,with intensive DCXC therapy being more effective.展开更多
Background:Diabetes mellitus(DM)is considered a cardiovascular risk factor.The aim of this study was to analyze the prevalence and volume of coronary artery plaque in patients with diabetes mellitus(DM)vs.those withou...Background:Diabetes mellitus(DM)is considered a cardiovascular risk factor.The aim of this study was to analyze the prevalence and volume of coronary artery plaque in patients with diabetes mellitus(DM)vs.those without DM.Methods:This study recruited consecutive patients who underwent coronary computed tomography(CT)angiography(CCTA)between October 2016 and November 2017.Personal information including conventional cardiovascular risk factors was collected.Plaque phenotypes were automatically calculated for volume of different component.The volume of different plaque was compared between DM patients and those without DM.Results:Among 6381 patients,931(14.59%)were diagnosed with DM.The prevalence of plaque in DM subjects was higher compared with nondiabetic group significantly(48.34%vs.33.01%,χ2=81.84,P<0.001).DM was a significant risk factor for the prevalence of plaque in a multivariate model(odds ratio[OR]=1.465,95%CI:1.258-1.706,P<0.001).The volume of total plaque and any plaque subtypes in the DM subjects was greater than those in nondiabetic patients significantly(P<0.001).Conclusion:The coronary artery atherosclerotic plaques were significantly higher in diabetic patients than those in non-diabetic patients.展开更多
BACKGROUND Management of chronic total occlusions(CTO)in diabetics is challenging,with a recent trend towards early revascularization[ER:Percutaneous coronary intervention(PCI)and bypass grafting]instead of optimal me...BACKGROUND Management of chronic total occlusions(CTO)in diabetics is challenging,with a recent trend towards early revascularization[ER:Percutaneous coronary intervention(PCI)and bypass grafting]instead of optimal medical therapy(OMT).We hypothesize that ER improves morbidity and mortality outcomes in diabetic patients with CTOs as compared to OMT.AIM To determine the long term clinical outcomes and to compare morbidity and mortality between OMT and ER in diabetic patients with CTOs.METHODS Potentially relevant published clinical trials were identified in Medline,Embase,chemical abstracts and Biosis(from start of the databases till date)and pooled hazard ratios(HR)computed using a random effects model,with significant P value<0.05.Primary outcome of interest was all-cause death.Secondary outcomes included cardiac death,prompt revascularization(ER)or repeat myocardial infarction(MI).Due to scarcity of data,both Randomized control trials and observational studies were included.4 eligible articles,containing 2248 patients were identified(1252 in OMT and 1196 in ER).Mean follow-up was 45-60 mo.RESULTS OMT was associated with a higher all-cause mortality[HR:1.70,95%confidence interval(CI):0.80-3.26,P=0.11]and cardiac mortality(HR:1.68,95%CI:0.96-2.96,P=0.07).Results were close to significance.The risk of repeat MI was almost the same in both groups(HR:0.97,95%CI:0.61-1.54,P=0.90).Similarly,patients assigned to OMT had a higher risk of repeat revascularization(HR:1.62,95%CI:1.36-1.94,P<0.00001).Sub-group analysis of OMT vs PCI demonstrated higher all-cause(HR:1.98,95%CI:1.36-2.87,P=0.0003)and cardiac mortality(HR:1.87,95%CI:0.96-3.62,P=0.06)in the OMT group.The risk of repeat MI was low in the OMT group vs PCI(HR:0.53,95%CI:0.31-0.91,P=0.02).Data on repeat revascularization revealed no difference between the two(HR:1.00,95%CI:0.52-1.93,P=1.00).CONCLUSION In diabetic patients with CTO,there was a trend for improved outcomes with ER regarding all-cause and cardiac death as compared to OMT.These findings were reinforced with statistical significance on subgroup analysis of OMT vs PCI.展开更多
文摘BACKGROUND It is increasingly common to find patients affected by a combination of type 2 diabetes mellitus(T2DM)and coronary artery disease(CAD),and studies are able to correlate their relationships with available biological and clinical evidence.The aim of the current study was to apply association rule mining(ARM)to discover whether there are consistent patterns of clinical features relevant to these diseases.ARM leverages clinical and laboratory data to the meaningful patterns for diabetic CAD by harnessing the power help of data-driven algorithms to optimise the decision-making in patient care.AIM To reinforce the evidence of the T2DM-CAD interplay and demonstrate the ability of ARM to provide new insights into multivariate pattern discovery.METHODS This cross-sectional study was conducted at the Department of Biochemistry in a specialized tertiary care centre in Delhi,involving a total of 300 consented subjects categorized into three groups:CAD with diabetes,CAD without diabetes,and healthy controls,with 100 subjects in each group.The participants were enrolled from the Cardiology IPD&OPD for the sample collection.The study employed ARM technique to extract the meaningful patterns and relationships from the clinical data with its original value.RESULTS The clinical dataset comprised 35 attributes from enrolled subjects.The analysis produced rules with a maximum branching factor of 4 and a rule length of 5,necessitating a 1%probability increase for enhancement.Prominent patterns emerged,highlighting strong links between health indicators and diabetes likelihood,particularly elevated HbA1C and random blood sugar levels.The ARM technique identified individuals with a random blood sugar level>175 and HbA1C>6.6 are likely in the“CAD-with-diabetes”group,offering valuable insights into health indicators and influencing factors on disease outcomes.CONCLUSION The application of this method holds promise for healthcare practitioners to offer valuable insights for enhancing patient treatment targeting specific subtypes of CAD with diabetes.Implying artificial intelligence techniques with medical data,we have shown the potential for personalized healthcare and the development of user-friendly applications aimed at improving cardiovascular health outcomes for this high-risk population to optimise the decision-making in patient care.
文摘Background: Diabetes mellitus (DM) is independently associated with an increased risk of cardiovascular mortality and morbidity, including coronary artery disease (CAD). CAD is a shared burden disease and the leading cause of death in developed and developing countries. We aimed to assess the angiographic patterns of coronary arteries in patients with DM in a developing country (Yemen) as the first study. Methods: This study is a cross-sectional, prospective, observational study that includes a total of 250 patients who were admitted for elective diagnostic coronary angiography. Results: 96 (38.4%) patients were diabetics;68% were male;mean age was 57 ± 11 years. The incidence of three-vessel disease was 31.2% of patients. Considering the severity of lumen occlusion, (11.2%) of patients had non-significant lesions, (37.6%) of patients had significant lesions, and (32%) had total occlusive lesions. Lesions were of LAD in 76%, RCA in 60%, and LCX in 52% of the population. Among diabetics, two and 3-vessel diseases (33.3% vs. 20.8% & 50% vs. 19.5%, P = 0.001), left main lesion (10.4% vs. 2.6%, P = 0.012), significant stenosis (41.7% vs. 35.1%, P = 0.032), total occlusion of coronary arteries (43.8% vs. 19.5%, P = 0.032) and type C lesion (66.7% vs. 35.1%, P = 0.010) were more frequent than non-DM patients. Conclusion: The burden of significant and severe coronary lesions is more common among DM, which may be the major cause of morbidity and mortality of DM in developing countries.
文摘Objectives To study clini- cal and coronary angiographic findings in patients with both coronary heart diseases (CHD) and type 2 diabe- tes mellitus (T2DM). Methods 215 patients with CHD confirmed by coronary angiography were involved in this study. The patients were divided into two groups: 74 CHD patients with T2DM (mean age 64.7 ± 8.2 years, male/female 47/27), and 141 CHD pa- tients without T2DM ( mean age 66. 2 ±9. 2 years, male/female 100/41 ). The clinical features and the data from selective coronary angiographies were com- pared between type 2 diabetic and non - diabetic CHD patients. Results Compared to non - diabetic CHD patients, the patients with both CHD and T2DM suf- fered more from acute myocardial infarction, silent is- chemia and severe arrhythmias ( P < 0. 01, P < 0. 05 ) , and had higher serum triglycerides and apo - lipoprotein B, along with increased serum uric acid (P < 0. 01, P < 0.05), increased left ventricular end diastolic diameter ( P < 0. 01 ) , and decreased left ventricular ejection fraction ( P < 0. 001 ). Compared to non - diabetic CHD patients, the patients with both CHD and T2DM suffered more from triple vessel disease (P < 0. 01) , severe coronary artery stenosis, complete occlusions and diffuse lesions ( P < 0. 001). Conclusions Se- vere clinical manifestation, left ventricular dysfunction, diffuse or complicated lesions of coronary arteries weremore common in patients with both CHD and T2DM, it suggests that the type 2 diabetic CHD patients have poor prognosis.
文摘OBJECTIVE: To study the protective effects of Dongchongxiacao(Cordyceps)(DCXC) on contrast-induced nephropathy(CIN) in patients with type 2 diabetes and renal insufficiency undergoing coronary angiography.METHODS: A total of 120 patients with type 2 diabetes whose estimated glomerular filtration rate(e GFR) was ≤ 60 m L/minee grou·1.73 m2,were divided randomly into thrps,basic treatment group(n = 41),standard DCXC therapy group(n = 39,2-g corbrin capsules,3 times/d,3 days before and after angiography),and intensive DCXC therapy group(n = 40,3-g corbrin capsules,3 times/d,3 days before and after angiography). Serum creatinine(Scr)and e GFR were assessed at the time of admission to hospital,and on days 1,2 and 3 after angiography. Urine neutrophil-gelatinase-associated-lipocalin(NGAL),kidney injury molecule-1(KIM-1) and interleukin-18(IL-18) were measured before angiography and at day 1 after angiography for all patients. The primary end point was the prevalence of CIN. The secondary end point was a 25% or greater reduction in e GFR.RESULTS: CIN occurred in 11 of 120 patients(9.17 %). The prevalence of CIN was lower in the DCXC treatment groups than in the basic treatment group(P < 0.05),with a more significant decrease in the prevalence of CIN in the intensive DCXC therapy group(P < 0.01). Compared with the basic treatment group,a lower proportion of patients in the DCXC treatment groups had an e GFR decrease of 25% or greater(P < 0.05); patients with an e GFR decrease of 25% or greater accounted for an even lower proportion in the intensive DCXC therapy group(P < 0.01). Within 1 day of the procedure,urine levels of KIM-1,NGAL and IL-18 in patients in the intensive DCXC therapy group were lower than those in the basic treatment group and standard therapy group(P < 0.05).CONCLUSION: DCXC treatment may protect against CIN in patients with type 2 diabetes and renal insufficiency undergoing coronary angiography,with intensive DCXC therapy being more effective.
基金supported by a grant from National Key Research and Development Plan(No.2016YFC1300400)。
文摘Background:Diabetes mellitus(DM)is considered a cardiovascular risk factor.The aim of this study was to analyze the prevalence and volume of coronary artery plaque in patients with diabetes mellitus(DM)vs.those without DM.Methods:This study recruited consecutive patients who underwent coronary computed tomography(CT)angiography(CCTA)between October 2016 and November 2017.Personal information including conventional cardiovascular risk factors was collected.Plaque phenotypes were automatically calculated for volume of different component.The volume of different plaque was compared between DM patients and those without DM.Results:Among 6381 patients,931(14.59%)were diagnosed with DM.The prevalence of plaque in DM subjects was higher compared with nondiabetic group significantly(48.34%vs.33.01%,χ2=81.84,P<0.001).DM was a significant risk factor for the prevalence of plaque in a multivariate model(odds ratio[OR]=1.465,95%CI:1.258-1.706,P<0.001).The volume of total plaque and any plaque subtypes in the DM subjects was greater than those in nondiabetic patients significantly(P<0.001).Conclusion:The coronary artery atherosclerotic plaques were significantly higher in diabetic patients than those in non-diabetic patients.
文摘BACKGROUND Management of chronic total occlusions(CTO)in diabetics is challenging,with a recent trend towards early revascularization[ER:Percutaneous coronary intervention(PCI)and bypass grafting]instead of optimal medical therapy(OMT).We hypothesize that ER improves morbidity and mortality outcomes in diabetic patients with CTOs as compared to OMT.AIM To determine the long term clinical outcomes and to compare morbidity and mortality between OMT and ER in diabetic patients with CTOs.METHODS Potentially relevant published clinical trials were identified in Medline,Embase,chemical abstracts and Biosis(from start of the databases till date)and pooled hazard ratios(HR)computed using a random effects model,with significant P value<0.05.Primary outcome of interest was all-cause death.Secondary outcomes included cardiac death,prompt revascularization(ER)or repeat myocardial infarction(MI).Due to scarcity of data,both Randomized control trials and observational studies were included.4 eligible articles,containing 2248 patients were identified(1252 in OMT and 1196 in ER).Mean follow-up was 45-60 mo.RESULTS OMT was associated with a higher all-cause mortality[HR:1.70,95%confidence interval(CI):0.80-3.26,P=0.11]and cardiac mortality(HR:1.68,95%CI:0.96-2.96,P=0.07).Results were close to significance.The risk of repeat MI was almost the same in both groups(HR:0.97,95%CI:0.61-1.54,P=0.90).Similarly,patients assigned to OMT had a higher risk of repeat revascularization(HR:1.62,95%CI:1.36-1.94,P<0.00001).Sub-group analysis of OMT vs PCI demonstrated higher all-cause(HR:1.98,95%CI:1.36-2.87,P=0.0003)and cardiac mortality(HR:1.87,95%CI:0.96-3.62,P=0.06)in the OMT group.The risk of repeat MI was low in the OMT group vs PCI(HR:0.53,95%CI:0.31-0.91,P=0.02).Data on repeat revascularization revealed no difference between the two(HR:1.00,95%CI:0.52-1.93,P=1.00).CONCLUSION In diabetic patients with CTO,there was a trend for improved outcomes with ER regarding all-cause and cardiac death as compared to OMT.These findings were reinforced with statistical significance on subgroup analysis of OMT vs PCI.
