Effects of type 2 diabetes mellitus on coronary microvascular function and myocardial perfusion in patients without obstructive coronary artery disease

  • Caterina Marciano
  • Maurizio Galderisi
  • Paola Gargiulo
  • Wanda Acampa
  • Carmen D’Amore
  • Roberta Esposito
  • Enza Capasso
  • Gianluigi Savarese
  • Laura Casaretti
  • Francesco Lo Iudice
  • Giovanni Esposito
  • Giuseppe Rengo
  • Dario Leosco
  • Alberto Cuocolo
  • Pasquale Perrone-Filardi
Original Article

Abstract

Purpose

We assessed the impact of type 2 diabetes, in the presence of other major cardiovascular risk factors, on coronary microvascular function and myocardial perfusion in patients without obstructive coronary artery disease (CAD).

Methods

In this prospective study, 23 patients with type 2 diabetes and 26 nondiabetic patients matched for age, sex and other cardiovascular risk factors underwent a cold pressure test (CPT) and dipyridamole transthoracic echocardiography to determine their coronary flow (CF) ratio. Within 2 weeks, all diabetic patients also underwent dipyridamole-rest myocardial perfusion single-photon emission (MPS) CT. None of the patients with or without diabetes had significant CAD on invasive coronary angiography.

Results

The CPT-CF ratio was significantly lower in diabetic patients than in nondiabetic patients (1.46 ± 0.26 vs. 1.71 ± 0.32, p = 0.006) and was correlated significantly with fasting glycaemia (r = −0.35, p = 0.01), but not with glycated haemoglobin. The dipyridamole-CF ratio was also lower in diabetic patients than in nondiabetic patients (2.38 ± 0.74 vs. 2.75 ± 0.49, p = 0.04). On MPS imaging, 5 diabetic patients (22%) had stress-induced ischaemia and the remaining 18 (78%) had normal myocardial perfusion. The dipyridamole-CF ratio was not different in patients with and without reversible defects (2.3 ± 1.1 vs. 2.4 ± 0.6, p = 0.97).

Conclusion

Coronary microvascular function is impaired in type 2 diabetic patients without significant CAD, compared to nondiabetic patients with similar other cardiovascular risk factors. In the majority of diabetic patients, microvascular dysfunction is associated with normal myocardial perfusion.

Keywords

Type 2 diabetes mellitus Microvascular dysfunction Myocardial perfusion imaging 

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Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • Caterina Marciano
    • 1
  • Maurizio Galderisi
    • 2
  • Paola Gargiulo
    • 1
  • Wanda Acampa
    • 3
  • Carmen D’Amore
    • 1
  • Roberta Esposito
    • 2
  • Enza Capasso
    • 4
  • Gianluigi Savarese
    • 1
  • Laura Casaretti
    • 1
  • Francesco Lo Iudice
    • 1
  • Giovanni Esposito
    • 1
  • Giuseppe Rengo
    • 1
  • Dario Leosco
    • 1
  • Alberto Cuocolo
    • 4
    • 5
  • Pasquale Perrone-Filardi
    • 1
  1. 1.Department of Clinical Medicine, Cardiovascular and Immunological SciencesUniversity Federico IINapoliItaly
  2. 2.Department of Clinical and Experimental MedicineUniversity Federico IINapoliItaly
  3. 3.Institute of Biostructures and BioimagesNational Council of ResearchNapoliItaly
  4. 4.Department of Biomorphological and Functional SciencesUniversity Federico IINapoliItaly
  5. 5.SDN Foundation, Institute of Diagnostic and Nuclear DevelopmentNapoliItaly

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