Coronary microvascular function is independently associated with left ventricular filling pressure in patients with type 2 diabetes mellitus

Takayuki Kawata, Masao Daimon, Sakiko Miyazaki, Ryoko Ichikawa, Masaki Maruyama, Shuo Ju Chiang, Chiharu Ito, Fumihiko Sato, Hirotaka Watada, Hiroyuki Daida

Research output: Contribution to journalArticlepeer-review

46 Citations (Scopus)

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 0.14mg/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 >2.0mg/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.

Original languageEnglish
Article number98
JournalCardiovascular Diabetology
Volume14
Issue number1
DOIs
Publication statusPublished - Aug 5 2015

Keywords

  • Coronary flow reserve
  • Diastolic dysfunction
  • Microvascular disease
  • Type 2 diabetes mellitus

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Cardiology and Cardiovascular Medicine

Fingerprint

Dive into the research topics of 'Coronary microvascular function is independently associated with left ventricular filling pressure in patients with type 2 diabetes mellitus'. Together they form a unique fingerprint.

Cite this