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Coronary microvascular function is independently associated with left ventricular filling pressure in patients with type 2 diabetes mellitus.

Kawata T, Daimon M, Miyazaki S, Ichikawa R, Maruyama M, Chiang SJ, Ito C, Sato F, Watada H, Daida H - Cardiovasc Diabetol (2015)

Bottom Line: In univariate analysis, age, presence of hypertension, LV mass index, estimated glomerular filtration rate and CFR were significantly associated with E/e'.CFR was associated with LV filling pressure in patients with type 2 diabetes.This result suggests a possible link between coronary microvascular disease and LV diastolic function in these subjects.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiology, Juntendo University School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan. dqh07724@nifty.ne.jp.

ABSTRACT

Background: Left ventricular (LV) diastolic dysfunction is known as an early marker of myocardial alterations in patients with diabetes. Because microvascular disease has been regarded as an important cause of heart failure or diastolic dysfunction in diabetic patients, we tested the hypothesis that coronary flow reserve (CFR), which reflects coronary microvascular function, is associated with LV diastolic dysfunction in patients with type 2 diabetes.

Methods: We studied asymptomatic patients with type 2 diabetes but without overt heart failure. Transthoracic Doppler echocardiography was performed that included pulsed tissue Doppler of the mitral annulus and CFR of the left anterior descending artery (induced by adenosine 0.14 mg/kg/min). The ratio of mitral velocity to early diastolic velocity of the mitral annulus (E/e') was used as a surrogate marker of diastolic function. We also evaluated renal function, lipid profile, parameters of glycemic control and other clinical characteristics to determine their association with E/e'. Patients with LV ejection fraction <50%, atrial fibrillation, valvular disease, regional wall motion abnormality, renal failure (serum creatinine >2.0 mg/dl) or type 1 diabetes were excluded. Patients with a CFR <2.0 were also excluded based on the suspicion of significant coronary artery stenosis.

Results: We included 67 asymptomatic patients with type 2 diabetes and 14 non-diabetic controls in the final study population. In univariate analysis, age, presence of hypertension, LV mass index, estimated glomerular filtration rate and CFR were significantly associated with E/e'. Multivariate analysis indicated that both LV mass index and CFR were independently associated with E/e'. In contrast, there were no significant associations between parameters of glycemic control and E/e'.

Conclusions: CFR was associated with LV filling pressure in patients with type 2 diabetes. This result suggests a possible link between coronary microvascular disease and LV diastolic function in these subjects.

No MeSH data available.


Related in: MedlinePlus

Example of Doppler tracing of LAD blood flow during baseline and after adenosine injection (hyperemia).
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Fig1: Example of Doppler tracing of LAD blood flow during baseline and after adenosine injection (hyperemia).

Mentions: Blood flow velocity in the distal portion of the left anterior descending (LAD) coronary artery was measured with a high-frequency transducer (5–7 MHz) under color Doppler flow guidance. With a sample volume (2.5 or 3.0 mm wide) positioned on the color signal in the LAD, Doppler spectral tracings of flow velocity in the LAD were recorded using a fast Fourier transformation. We first recorded baseline spectral Doppler signals in the LAD, then an intravenous adenosine was administered (0.14 mg/kg/min) to record spectral Doppler signals during hyperemia (Fig. 1). Mean and peak diastolic velocities were measured at baseline and peak hyperemic conditions from the Doppler signal recordings. Measurements were averaged over three cardiac cycles. In this study, CFR was defined as the ratio of hyperemic to basal mean diastolic coronary flow velocity. To determine the reproducibility of mean diastolic velocity, a total of ten randomly selected measurements were analyzed twice by one investigator at a 1-week interval and once by another investigator.Fig. 1


Coronary microvascular function is independently associated with left ventricular filling pressure in patients with type 2 diabetes mellitus.

Kawata T, Daimon M, Miyazaki S, Ichikawa R, Maruyama M, Chiang SJ, Ito C, Sato F, Watada H, Daida H - Cardiovasc Diabetol (2015)

Example of Doppler tracing of LAD blood flow during baseline and after adenosine injection (hyperemia).
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4525728&req=5

Fig1: Example of Doppler tracing of LAD blood flow during baseline and after adenosine injection (hyperemia).
Mentions: Blood flow velocity in the distal portion of the left anterior descending (LAD) coronary artery was measured with a high-frequency transducer (5–7 MHz) under color Doppler flow guidance. With a sample volume (2.5 or 3.0 mm wide) positioned on the color signal in the LAD, Doppler spectral tracings of flow velocity in the LAD were recorded using a fast Fourier transformation. We first recorded baseline spectral Doppler signals in the LAD, then an intravenous adenosine was administered (0.14 mg/kg/min) to record spectral Doppler signals during hyperemia (Fig. 1). Mean and peak diastolic velocities were measured at baseline and peak hyperemic conditions from the Doppler signal recordings. Measurements were averaged over three cardiac cycles. In this study, CFR was defined as the ratio of hyperemic to basal mean diastolic coronary flow velocity. To determine the reproducibility of mean diastolic velocity, a total of ten randomly selected measurements were analyzed twice by one investigator at a 1-week interval and once by another investigator.Fig. 1

Bottom Line: In univariate analysis, age, presence of hypertension, LV mass index, estimated glomerular filtration rate and CFR were significantly associated with E/e'.CFR was associated with LV filling pressure in patients with type 2 diabetes.This result suggests a possible link between coronary microvascular disease and LV diastolic function in these subjects.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiology, Juntendo University School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan. dqh07724@nifty.ne.jp.

ABSTRACT

Background: Left ventricular (LV) diastolic dysfunction is known as an early marker of myocardial alterations in patients with diabetes. Because microvascular disease has been regarded as an important cause of heart failure or diastolic dysfunction in diabetic patients, we tested the hypothesis that coronary flow reserve (CFR), which reflects coronary microvascular function, is associated with LV diastolic dysfunction in patients with type 2 diabetes.

Methods: We studied asymptomatic patients with type 2 diabetes but without overt heart failure. Transthoracic Doppler echocardiography was performed that included pulsed tissue Doppler of the mitral annulus and CFR of the left anterior descending artery (induced by adenosine 0.14 mg/kg/min). The ratio of mitral velocity to early diastolic velocity of the mitral annulus (E/e') was used as a surrogate marker of diastolic function. We also evaluated renal function, lipid profile, parameters of glycemic control and other clinical characteristics to determine their association with E/e'. Patients with LV ejection fraction <50%, atrial fibrillation, valvular disease, regional wall motion abnormality, renal failure (serum creatinine >2.0 mg/dl) or type 1 diabetes were excluded. Patients with a CFR <2.0 were also excluded based on the suspicion of significant coronary artery stenosis.

Results: We included 67 asymptomatic patients with type 2 diabetes and 14 non-diabetic controls in the final study population. In univariate analysis, age, presence of hypertension, LV mass index, estimated glomerular filtration rate and CFR were significantly associated with E/e'. Multivariate analysis indicated that both LV mass index and CFR were independently associated with E/e'. In contrast, there were no significant associations between parameters of glycemic control and E/e'.

Conclusions: CFR was associated with LV filling pressure in patients with type 2 diabetes. This result suggests a possible link between coronary microvascular disease and LV diastolic function in these subjects.

No MeSH data available.


Related in: MedlinePlus