Intractable coronary artery disease in a patient with type 2 diabetes presenting with triglyceride deposit cardiomyovasculopathy

Abstract

A 51-year-old man with sudden cardiac death despite multiple percutaneous coronary interventions (PCIs) and coronary artery bypass graft surgery The patient was overweight since adolescence and diagnosed with type 2 diabetes at age 26 Severely deteriorated insulin sensitivity indicated by the rate constant for plasma glucose disappearance by the insulin tolerance test (KITT) (0.87%) and endogenous hyperinsulinemia suspected from total daily urinary C-peptide excretion (242.8 mg) at age 35. KITT value progressively deteriorated to 0.49, 0.32, and 0.25% at ages 38, 39, and 40, respectively High dosage (320 units) of total daily insulin injection at age 49 Acute myocardial infarction at age 36 and multiple PCIs at ages 36, 47, and 48 Diffuse narrowing of coronary arteries accompanying abundant triglyceride deposition within coronary wall demonstrated by coronary computed tomography (CT) angiography with color-coded display A remarkably reduced washout rate (211%) in myocardial scintigraphy with [123I]-b-methyl iodophenyl-pentadecanoic acid (BMIPP) at age 50 The above two features were consistent with triglyceride deposit cardiomyovasculopathy (TGCV) His younger brother also died of acute myocardial infarction at age 38 He had nonalcoholic steatohepatitis (NASH) and multiple diabetic microvascular complications, including visual loss and end-stage nephropathy