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Insulin resistance is a major determinant of myocardial blood flow impairment in anginal patients

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

In patients with chest pain, stress-induced myocardial perfusion abnormalities are often the result of depressed myocardial blood flow (MBF) reserve. We investigated the relative contribution of cardiovascular risk factors and coronary atherosclerosis to MBF abnormalities in anginal patients.

Methods

We studied 167 patients with typical (n = 100) or atypical (n = 67) chest pain who underwent quantitative evaluation of MBF by PET at rest and after dipyridamole infusion, and quantitative coronary angiography (invasive or by 64-slice CT). Patients with left ventricular (LV) dysfunction (ejection fraction <45 %) were excluded. Coronary atherosclerosis of ≥50 % was defined as obstructive.

Results

At rest median MBF was 0.60 ml min−1 g−1, and after dipyridamole infusion median MBF was 1.22 ml min−1 g−1. MBF reserve was <2 in 77 of 167 patients (46 %). Coronary atherosclerosis was present in 67 patients (40 %), 26 with obstructive disease. In a univariate analysis several variables were associated with reduced MBF at rest, including male gender, coronary atherosclerosis and elevated LV end-diastolic diameter, and during hyperaemia, including male gender, insulin resistance (IR), smoking habit, LV ejection fraction and end-diastolic diameter. In a multivariate analysis, after adjustment for LV function and for pharmacological treatments, male gender was the only independent predictor of reduced MBF at rest (P < 0.001), while male gender (P = 0.003), IR (P = 0.033) and coronary atherosclerosis (P < 0.001) remained the only independent predictors of reduced hyperaemic MBF. IR (P = 0.043) and coronary atherosclerosis (P = 0.005) were the only predictors of depressed MBF reserve. Coronary atherosclerosis, male gender and IR showed additive effects on hyperaemic MBF.

Conclusion

In patients with chest pain and normal LV systolic function, IR, male gender and coronary atherosclerosis are independent and additive determinants of impaired hyperaemic MBF.

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Acknowledgments

We thank Piero Salvadori, Luca Menichetti and Silvia Pardini for their participation to the cardiac PET studies. This study was partially supported by a grant from the European Union FP7-CP-FP 2007 project (grant agreement no. 222915, EVINCI).

Conflicts of interest

None.

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Authors and Affiliations

  1. Scuola Superiore Sant’Anna, Pisa, Italy

    Riccardo Liga, Cecilia Vecoli & Antonio L’Abbate

  2. CNR, Institute of Clinical Physiology, Via G. Moruzzi 1, 56124, Pisa, Italy

    Daniele Rovai, Tiziana Sampietro, Chiara Caselli, Giuseppe Rossi & Danilo Neglia

  3. Fondazione Toscana G. Monasterio, Pisa, Italy

    Giancarlo Todiere & Danilo Neglia

Authors
  1. Riccardo Liga
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  2. Daniele Rovai
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  3. Tiziana Sampietro
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  4. Cecilia Vecoli
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  5. Giancarlo Todiere
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  6. Chiara Caselli
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  8. Antonio L’Abbate
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  9. Danilo Neglia
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Correspondence to Danilo Neglia.

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Liga, R., Rovai, D., Sampietro, T. et al. Insulin resistance is a major determinant of myocardial blood flow impairment in anginal patients. Eur J Nucl Med Mol Imaging 40, 1905–1913 (2013). https://doi.org/10.1007/s00259-013-2523-7

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  • DOI: https://doi.org/10.1007/s00259-013-2523-7

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