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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

Patient flow diagram. Of the consecutive 75 patients who were studied, 8 were excluded. Sixty-seven patients were enrolled and completed the entire protocol.
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Fig2: Patient flow diagram. Of the consecutive 75 patients who were studied, 8 were excluded. Sixty-seven patients were enrolled and completed the entire protocol.

Mentions: Among 75 patients, 2 patients (3%) were excluded because they had LV ejection fraction <50%. None of the patients had a positive exercise stress test. Six patients (8%) had CFR <2.0. Therefore, the final study population consisted of 67 patients (50 male; mean age, 57 ± 12 years) with type 2 diabetes who met the inclusion criteria (Fig. 2). All 14 of the non-diabetic controls had CFR ≥2.0, LV ejection fraction ≥50%, no symptoms or history of cardiovascular disease, and no regional LV wall motion abnormalities.Fig. 2


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)

Patient flow diagram. Of the consecutive 75 patients who were studied, 8 were excluded. Sixty-seven patients were enrolled and completed the entire protocol.
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

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

Fig2: Patient flow diagram. Of the consecutive 75 patients who were studied, 8 were excluded. Sixty-seven patients were enrolled and completed the entire protocol.
Mentions: Among 75 patients, 2 patients (3%) were excluded because they had LV ejection fraction <50%. None of the patients had a positive exercise stress test. Six patients (8%) had CFR <2.0. Therefore, the final study population consisted of 67 patients (50 male; mean age, 57 ± 12 years) with type 2 diabetes who met the inclusion criteria (Fig. 2). All 14 of the non-diabetic controls had CFR ≥2.0, LV ejection fraction ≥50%, no symptoms or history of cardiovascular disease, and no regional LV wall motion abnormalities.Fig. 2

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