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

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

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.

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Conflicts of interest

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Authors and Affiliations

  1. Department of Clinical Medicine, Cardiovascular and Immunological Sciences, University Federico II, Napoli, Italy

    Caterina Marciano, Paola Gargiulo, Carmen D’Amore, Gianluigi Savarese, Laura Casaretti, Francesco Lo Iudice, Giovanni Esposito, Giuseppe Rengo, Dario Leosco & Pasquale Perrone-Filardi

  2. Department of Clinical and Experimental Medicine, University Federico II, Napoli, Italy

    Maurizio Galderisi & Roberta Esposito

  3. Institute of Biostructures and Bioimages, National Council of Research, Napoli, Italy

    Wanda Acampa

  4. Department of Biomorphological and Functional Sciences, University Federico II, Napoli, Italy

    Enza Capasso & Alberto Cuocolo

  5. SDN Foundation, Institute of Diagnostic and Nuclear Development, Napoli, Italy

    Alberto Cuocolo

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  1. Caterina Marciano
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  15. Pasquale Perrone-Filardi
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Correspondence to Alberto Cuocolo or Pasquale Perrone-Filardi.

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Marciano, C., Galderisi, M., Gargiulo, P. et al. Effects of type 2 diabetes mellitus on coronary microvascular function and myocardial perfusion in patients without obstructive coronary artery disease. Eur J Nucl Med Mol Imaging 39, 1199–1206 (2012). https://doi.org/10.1007/s00259-012-2117-9

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  • DOI: https://doi.org/10.1007/s00259-012-2117-9

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