Is chronic diabetic foot ulcer an indicator of cardiac disease?

NewsBot · Jan 25, 2008

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Is chronic diabetic foot ulcer an indicator of cardiac disease?
Löndahl M, Katzman P, Fredholm O, Nilsson A, Apelqvist J.
J Wound Care. 2008 Jan;17(1):12-6.

OBJECTIVE: To evaluate presence and severity of cardiac disease in individuals with chronic diabetic foot ulcers using echocardiography.

METHOD: Eighty consecutive patients with chronic foot ulcers attending the multidisciplinary diabetes foot clinic at Helsingborg Hospital underwent clinical examination, toe blood pressure measurement and a standard echocardiographic examination.

RESULTS: Sixty-nine percent of the patients had a history of myocardial infarction and/or hypertension and/or heart failure; 78% had signs of left ventricular dysfunction and/or left ventricular hypertrophy and/or diastolic dysfunction; 76% of the patients without a history of cardiovascular disease had signs of cardiac dysfunction on echocardiography.

CONCLUSION: Cardiac dysfunction is a common occurrence present in patients with chronic diabetic foot ulcers, even in those without known cardiac disease or hypertension. Echocardiography may be recommended as a screening procedure in the management of diabetic patients with chronic foot ulcers. The present study supports the view that diabetic chronic foot ulcers ought to be seen as a sign of cardiac disease, although further research is needed to elucidate this issue.
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NewsBot · Jan 27, 2008

Ischemic stroke in patients with diabetic foot
Pinto A., Tuttolomondo A., Di Raimondo D., La Placa S., Di Sciacca R., Fernandez P., Di Gati M., Raffa A., Licata G.
International Angiology 2007 - Vol. 26 - N. 03 - September - pag. 266

Aim. The diabetic foot syndrome is the most frequent cause of hospitalization of diabetic patients and one of the economically most demanding complications of diabetes. People with diabetes have been shown to have higher mortality than people without diabetes, but the cerebrovascular risk profile of these patients is not fully evaluated. The aim of our study was to evaluate the possible role of diabetic foot as a cerebrovascular risk marker in type 2 diabetic patients.

Methods. We enrolled 102 type 2 diabetes patients with diabetic foot and 123 diabetic patients without diabetic foot.

Results. Statistically significant differences were found in the distribution of the main cardiovascular risk factors with exception of hypertension. We observed a higher prevalence of previous cerebrovascular events (transient ischemic attack, ischemic stroke) and of incidence of new onset cerebrovascular events at a 5-year follow-up. Regarding clinical subtype of ischemic stroke classified according to Trial of ORG 10172 in Acute Stroke Treatment (TOAST) classification on a retrospective and prospective basis, we observed a higher prevalence of both the lacunar and large artery atherosclerosis subtype with a slight higher prevalence of lacunar subtype in patients with diabetic foot.

Conclusion. Our results show a worse cerebrovascular risk profile in diabetic patients with diabetic foot than in diabetic subjects without foot ulceration with a higher prevalence of cardiovascular risk factors and of anamnestic cerebrovascular events and incidence of new cerebrovascular events at a 5-year follow-up.
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NewsBot · Apr 30, 2008

Cardiovascular risk profile and morbidity in subjects affected by type 2 diabetes mellitus with and without diabetic foot.
Pinto A, Tuttolomondo A, Di Raimondo D, Fernandez P, La Placa S, Di Gati M, Licata G.
Metabolism. 2008 May;57(5):676-82.

Diabetic foot syndrome (DFS) is the most frequent cause of hospitalization of diabetic patients and one of the most economically demanding complications of diabetes. People with diabetes have been shown to have higher mortality than people without diabetes. On this basis, the aim of our study was to evaluate the possible role of diabetic foot as a cardiovascular risk marker in patients with type 2 diabetes mellitus. We enrolled 102 consecutive patients with type 2 diabetes mellitus with diabetic foot and 123 patients with type 2 diabetes mellitus without limb lesions to compare the prevalence of main cardiovascular risk factors, subclinical cardiovascular disease, previous cardiovascular morbidity, and incidence of new vascular events on a 5-year follow-up. Diabetic patients with diabetic foot were more likely to have a higher prevalence of cardiovascular risk factors such as hypercholesterolemia, hypertriglyceridemia, hyperuricemia, and microalbuminuria or proteinuria, a higher prevalence of a previous cardiovascular morbidity (coronary artery disease, transient ischemic attack/ischemic stroke, diabetic retinopathy), and a higher prevalence of subclinical cardiovascular disease. Furthermore, diabetic patients with foot ulceration showed, on a 5-year follow-up, a higher incidence of new-onset vascular events (coronary artery disease, transient ischemic attack/ischemic stroke, diabetic retinopathy). At multivariate analysis, duration of diabetes, age, hemoglobin A(1c), and DFS maintained a significant association with cardiovascular morbidity; but DFS presence showed the highest hazard ratio.
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markjohconley · Apr 30, 2008

And vica versa, no? Isn't ischaemic heart disease in people with diabetes an indicator of "high risk feet" ulcers?

markjohconley · Apr 30, 2008

Should read

"an indicator of SUSCEPTIBILITY for "high risk feet" ulcers?"

or something like that

NewsBot · Mar 15, 2021

Analysis of the results of patients treatment with metabolic syndrome, diabetic foot syndrome combined with diastolic dysfunction of the left ventricle
Myroslav Kritsak et al
Pol Merkur Lekarski. 2021 Feb 24;49(289):32-34.

Obesity is one of the most serious and common risk factors for cardiovascular disease that increases the risk of type 2 diabetes.

Aim: The aim of the study was to analyze the features of disorders of diastolic function of the left ventricle and the oxygenation of arterial and venous blood in patients with diabetic foot syndrome and metabolic syndrome with diastolic dysfunction of the left ventricle in its complex treatment with the using a course of hyperbaric oxygen therapy.

Materials and methods: An examination of 32 patients with diabetic foot syndrome, neuro-ischemic form (I stage - 8 patients, II stage - 24 patients) and metabolic syndrome, to determine an assessment was made of diastolic function of the left ventricle, determination of saturation of arterial and venous blood, oxygen content in arterial and venous blood, arterio-venous difference in oxygen. The control group consisted of 20 healthy individuals. These indicators were determined before starting the course of hyperbaric oxygen therapy and after completing the full course used 100 % oxygen, with the following parameters: working pressure of 1.7-1.8 at, with periods of compression and decompression of 10 minutes, isopression - 40-60 minutes. The total number of sessions was 8-10.

Results: The ratio peak rates of early- and late diastolic filling of the patients in the study group was significantly lower by 24.48 % (p <0.05) compared to the control group. Iso-volumetric relaxation and slowing of early diastolic filling also increased: by 21.02 % and by 7.26 % (p <0.05), respectively. Saturation of arterial blood after hyperbaric oxygenation sessions was 4.1% higher than the initial data. Saturation of venous blood before and after oxygen therapy was 52.64 ± 0.08 % and 58.25 ± 0.02 %, respectively. Oxygen content in arterial and venous blood before the start of the course was 121.57 ± 0.85 ml· L-1 and 127.20 ± 3.5 ml·L-1, respectively, and after treatment respectively 135.61 ± 0.06 ml·L-1 and 82.13 ± 0.01 ml·L-1. In addition, the volume of oxygen consumed by body tissues increased from 46.85 ± 0.84 ml·L-1 to 57.83 ± 4.3 ml·L-1.

Conclusions: The use of the course of the hyperbaric oxygen therapy contributed to the reduction of signs of diastolic heart failure and increased oxygenation rates of arterial and venous blood, the alignment of oxygen metabolism, contributed to the elimination of both systemic oxygen deficiency and local tissue hypoxia, due to which a complex therapeutic effect revealed.
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markjohconley Well-Known Member

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