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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

Inverse association between CFR and surrogate marker of LV filling pressure (E/e′) in patients with type 2 diabetes.
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Fig4: Inverse association between CFR and surrogate marker of LV filling pressure (E/e′) in patients with type 2 diabetes.

Mentions: Univariate and multivariate potential determinants of E/e′ were analyzed and summarized in Table 3. In univariate analysis, age, presence of hypertension, LV mass index, eGFR and CFR were significantly associated with E/e′. Female gender tended to show an association with high E/e′. Figure 4 shows the relation between CFR and E/e′; a significant inverse association between CFR and E/e′ was observed. CFR was also associated with e′, an index of myocardial relaxation (β = 0.26, p = 0.0319). There were no significant associations between E/e′ and parameters of glycemic control such as fasting blood sugar, glycosylated hemoglobin or HOMA-R. Multivariate analysis (including age, presence of hypertension, LV mass index, eGFR and CFR) showed that both LV mass index and CFR were independent determinants of E/e′ (Table 3).Table 3


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)

Inverse association between CFR and surrogate marker of LV filling pressure (E/e′) in patients with type 2 diabetes.
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

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

Fig4: Inverse association between CFR and surrogate marker of LV filling pressure (E/e′) in patients with type 2 diabetes.
Mentions: Univariate and multivariate potential determinants of E/e′ were analyzed and summarized in Table 3. In univariate analysis, age, presence of hypertension, LV mass index, eGFR and CFR were significantly associated with E/e′. Female gender tended to show an association with high E/e′. Figure 4 shows the relation between CFR and E/e′; a significant inverse association between CFR and E/e′ was observed. CFR was also associated with e′, an index of myocardial relaxation (β = 0.26, p = 0.0319). There were no significant associations between E/e′ and parameters of glycemic control such as fasting blood sugar, glycosylated hemoglobin or HOMA-R. Multivariate analysis (including age, presence of hypertension, LV mass index, eGFR and CFR) showed that both LV mass index and CFR were independent determinants of E/e′ (Table 3).Table 3

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