Remodelling Features of Heart and Postinfarction Cardiosclerosis Type 2 Diabetes: Relationship to Gene Polymorphisms LEPR Q223R

Objective. To establish the features of cardiac remodeling in patients with postinfarction cardiosclerosis and type 2 diabetes based on gene polymorphism leptin receptors LEPR Q223R. Materials and methods. The study involved 147 patients with stable coronary heart disease (CHD) with postinfarction cardiosclerosis (100.0 % of men aged 53.0 ± 7.83 years). Type 2 diabetes was detected in 64 (43.5 %) patients. CHD was established regarding the recommendations of the AHA/ACC (2014) and ESC (2013), verification of the diagnosis of type 2 diabetes was conducted under the existing criteria. Gene polymorphism LEPR Q223R determined by PCR mode Real­Time. Echocardiographic studies were performed in M­, B­ and D­mode on the ″Logic 500 Sono Series″ (General Electric, Korea). Results and discussion. In CHD patients with type 2 diabetes size of the left atrium was significantly higher than those in patients with CHD without diabetes. In men with postinfarction cardiosclerosis and type 2 diabetes was registered significantly higher myocardial mass, wall thickness, end systolic and diastolic dimensions than in patients without diabetes. In patients with CHD with type 2 diabetes final systolic size, end systolic volume, and end systolic extent index were significantly higher than in patients with CHD without diabetes. Presence of type 2 diabetes in patients with CHD was associated with the increase of end­diastolic volume, and left ventricular mass. In patients with postinfarction cardiosclerosis and type 2 diabetes was noted a significant worsening of cardiac systolic function: the degree of shortening of the anteroposterior size of the left ventricle (ΔS) in systole and ejection fraction were 7.4 and 6.6 % lower than in patients without diabetes. Among patients with CHD there were revealed 25.2 % homozygotes QQ, 42.4 % ­ QR ­ heterozygotes and 32.7 % ­ RR homozygotes. RR genotype was associated with a higher frequency of maladaptive remodeling type characterized by the dilation of the heart's chambers and thinning of the myocardium walls, especially in patients with type 2 diabetes. The frequency of the eccentric hypertrophy in homozygotes RR was 77.0 % and was significantly higher than among carriers of allele Q (OR = 4.60, 95,0% CI 2.13­9.94), while the frequency of concentric left ventricular hypertrophy was significantly lower (2.3­2.5 times, p < 0.05). Based on the multiple linear regression analysis it was confirmed that the genotype RR gene LEPR Q223R is an independent predictor of decrease of ejection fraction in patients with CHD associated with Type 2 diabetes. Conclusions. Gene polymorphism of LEPR Q223R is a predictor of maladaptive type of cardiac remodeling in patients with postinfarction cardiosclerosis and type 2 diabetes.