Relationship between vascular stiffness and stress myocardial perfusion imaging in asymptomatic patients with diabetes
Vascular stiffness may potentially be used as a screening tool to identify asymptomatic patients with diabetes with abnormal myocardial perfusion. The purpose of this study was therefore to determine the association between vascular stiffness, measured in term of pulse wave velocity (PWV) and augmentation index (AIx), and abnormal myocardial perfusion imaging (MPI) in asymptomatic patients with diabetes.
Prospectively, 160 asymptomatic patients with diabetes (mean age 51 years, 87 men) underwent MPI with adenosine stress. The summed stress score (SSS) was determined in each patient according to a 17-segment and five-point score. Abnormal MPI (SSS ≥3) was classified as moderate (SSS 3–7) or severe (SSS ≥8) MPI defects. Using applanation tonometry, the carotid–femoral PWV and the radial AIx corrected to 75 beats per minute were determined noninvasively.
MPI was abnormal in 61 patients (38%), with severe MPI defects in 22 patients (14%). Mean PWV increased with deteriorating MPI from 8.4 ± 2.2 m/s in normal MPI to 9.0 ± 2.2 m/s in moderate MPI defects (p = 0.11) and to 11.1 ± 2.5 m/s in severe MPI defects (p < 0.01). Likewise, mean AIx increased from 18.4 ± 13.4% to 19.4 ± 10.7% (p = 0.66) and to 25.4 ± 9.0% (p = 0.03). After adjustment for age and other risk factors, PWV remained a significant predictor of severe MPI defects (p = 0.01, OR 1.50, 95% CI 1.11–2.00), whereas AIx was no longer significant (p = 0.20).
Vascular stiffness measured by PWV is associated with severe MPI defects in asymptomatic patients with diabetes.
- Wild S, Roglic G, Green A, Sicree R, King H. Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. Diabetes Care. 2004;27(5):1047–53. CrossRef
- American Diabetes Association. Consensus development conference on the diagnosis of coronary heart disease in people with diabetes: 10-11 February 1998, Miami, Florida. Diabetes Care 1998;21(9):1551–9. CrossRef
- Kang X, Berman DS, Lewin HC, Cohen I, Friedman JD, Germano G, et al. Incremental prognostic value of myocardial perfusion single photon emission computed tomography in patients with diabetes mellitus. Am Heart J. 1999;138(6 Pt 1):1025–32. CrossRef
- Miller TD, Rajagopalan N, Hodge DO, Frye RL, Gibbons RJ. Yield of stress single-photon emission computed tomography in asymptomatic patients with diabetes. Am Heart J. 2004;147(5):890–6. CrossRef
- Young LH, Wackers FJ, Chyun DA, Davey JA, Barrett EJ, Taillefer R, et al. Cardiac outcomes after screening for asymptomatic coronary artery disease in patients with type 2 diabetes: the DIAD study: a randomized controlled trial. JAMA. 2009;301(15):1547–55. CrossRef
- Lakatta EG, Levy D. Arterial and cardiac aging: major shareholders in cardiovascular disease enterprises: Part I: aging arteries: a "set up" for vascular disease. Circulation. 2003;107(1):139–46. CrossRef
- Laurent S, Cockcroft J, Van Bortel L, Boutouyrie P, Giannattasio C, Hayoz D, et al. Expert consensus document on arterial stiffness: methodological issues and clinical applications. Eur Heart J. 2006;27(21):2588–605. CrossRef
- Stehouwer CD, Henry RM, Ferreira I. Arterial stiffness in diabetes and the metabolic syndrome: a pathway to cardiovascular disease. Diabetologia. 2008;51(4):527–39. CrossRef
- Mattace-Raso FU, van der Cammen TJ, Hofman A, van Popele NM, Bos ML, Schalekamp MA, et al. Arterial stiffness and risk of coronary heart disease and stroke: the Rotterdam Study. Circulation. 2006;113(5):657–63. CrossRef
- Weber T, Auer J, O'Rourke MF, Kvas E, Lassnig E, Berent R, et al. Arterial stiffness, wave reflections, and the risk of coronary artery disease. Circulation. 2004;109(2):184–9. CrossRef
- Weber T, Auer J, O'Rourke MF, Kvas E, Lassnig E, Lamm G, et al. Increased arterial wave reflections predict severe cardiovascular events in patients undergoing percutaneous coronary interventions. Eur Heart J. 2005;26(24):2657–63. CrossRef
- Williams B, Lacy PS, Thom SM, Cruickshank K, Stanton A, Collier D, et al. Differential impact of blood pressure-lowering drugs on central aortic pressure and clinical outcomes: principal results of the Conduit Artery Function Evaluation (CAFE) study. Circulation. 2006;113(9):1213–25. CrossRef
- Willum-Hansen T, Staessen JA, Torp-Pedersen C, Rasmussen S, Thijs L, Ibsen H, et al. Prognostic value of aortic pulse wave velocity as index of arterial stiffness in the general population. Circulation. 2006;113(5):664–70. CrossRef
- Rose G, McCartney P, Reid DD. Self-administration of a questionnaire on chest pain and intermittent claudication. Br J Prev Soc Med. 1977;31(1):42–8.
- Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Report of the expert committee on the diagnosis and classification of diabetes mellitus. Diabetes Care 2003;26 Suppl 1:S5–20.
- Hansen CL, Goldstein RA, Akinboboye OO, Berman DS, Botvinick EH, Churchwell KB, et al. Myocardial perfusion and function: single photon emission computed tomography. J Nucl Cardiol. 2007;14(6):e39–60. CrossRef
- Petretta M, Acampa W, Evangelista L, Daniele S, Ferro A, Cuocolo A. Impact of inducible ischemia by stress SPECT in cardiac risk assessment in diabetic patients: rationale and design of a prospective, multicenter trial. J Nucl Cardiol. 2008;15(1):100–4. CrossRef
- Wilkinson IB, Fuchs SA, Jansen IM, Spratt JC, Murray GD, Cockcroft JR, et al. Reproducibility of pulse wave velocity and augmentation index measured by pulse wave analysis. J Hypertens. 1998;16(12 Pt 2):2079–84. CrossRef
- Oliver JJ, Webb DJ. Noninvasive assessment of arterial stiffness and risk of atherosclerotic events. Arterioscler Thromb Vasc Biol. 2003;23(4):554–66. CrossRef
- Vlachopoulos C, Aznaouridis K, Stefanadis C. Prediction of cardiovascular events and all-cause mortality with arterial stiffness: a systematic review and meta-analysis. J Am Coll Cardiol. 2010;55(13):1318–27. CrossRef
- Cruickshank K, Riste L, Anderson SG, Wright JS, Dunn G, Gosling RG. Aortic pulse-wave velocity and its relationship to mortality in diabetes and glucose intolerance: an integrated index of vascular function? Circulation. 2002;106(16):2085–90. CrossRef
- Hatsuda S, Shoji T, Shinohara K, Kimoto E, Mori K, Fukumoto S, et al. Regional arterial stiffness associated with ischemic heart disease in type 2 diabetes mellitus. J Atheroscler Thromb. 2006;13(2):114–21. CrossRef
- Fukui M, Kitagawa Y, Nakamura N, Mogami S, Ohnishi M, Hirata C, et al. Augmentation of central arterial pressure as a marker of atherosclerosis in patients with type 2 diabetes. Diabetes Res Clin Pract. 2003;59(2):153–61. CrossRef
- Fantin F, Mattocks A, Bulpitt CJ, Banya W, Rajkumar C. Is augmentation index a good measure of vascular stiffness in the elderly? Age Ageing. 2007;36(1):43–8. CrossRef
- Hope SA, Antonis P, Adam D, Cameron JD, Meredith IT. Arterial pulse wave velocity but not augmentation index is associated with coronary artery disease extent and severity: implications for arterial transfer function applicability. J Hypertens. 2007;25(10):2105–9. CrossRef
- Hope SA, Tay DB, Meredith IT, Cameron JD. Use of arterial transfer functions for the derivation of central aortic waveform characteristics in subjects with type 2 diabetes and cardiovascular disease. Diabetes Care. 2004;27(3):746–51. CrossRef
- Lacy PS, O'Brien DG, Stanley AG, Dewar MM, Swales PP, Williams B. Increased pulse wave velocity is not associated with elevated augmentation index in patients with diabetes. J Hypertens. 2004;22(10):1937–44. CrossRef
- Wackers FJ, Young LH, Inzucchi SE, Chyun DA, Davey JA, Barrett EJ, et al. Detection of silent myocardial ischemia in asymptomatic diabetic subjects: the DIAD study. Diabetes Care. 2004;27(8):1954–61. CrossRef
- Chaitman BR, Hardison RM, Adler D, Gebhart S, Grogan M, Ocampo S, et al. The Bypass Angioplasty Revascularization Investigation 2 Diabetes randomized trial of different treatment strategies in type 2 diabetes mellitus with stable ischemic heart disease: impact of treatment strategy on cardiac mortality and myocardial infarction. Circulation. 2009;120(25):2529–40. CrossRef
- Frye RL, August P, Brooks MM, Hardison RM, Kelsey SF, MacGregor JM, et al. A randomized trial of therapies for type 2 diabetes and coronary artery disease. N Engl J Med. 2009;360(24):2503–15. CrossRef
- Relationship between vascular stiffness and stress myocardial perfusion imaging in asymptomatic patients with diabetes
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European Journal of Nuclear Medicine and Molecular Imaging
Volume 38, Issue 11 , pp 2050-2057
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- Diabetes mellitus
- Vascular stiffness
- Myocardial perfusion imaging
- Coronary artery disease
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- Author Affiliations
- 1. Department of Cardiology, C5-P, Leiden University Medical Center, Postbus 9600, 2300 RC, Leiden, The Netherlands
- 2. Interuniversity Cardiology Institute of the Netherlands (ICIN), Utrecht, The Netherlands
- 3. Department of Nephrology, Leiden University Medical Center, Leiden, The Netherlands
- 4. Department of Endocrinology, Leiden University Medical Center, Leiden, The Netherlands
- 5. Department of Nuclear Medicine, Leiden University Medical Center, Leiden, The Netherlands
- 6. Einthoven Laboratory of Experimental Vascular Medicine, Leiden, The Netherlands