Coronary microvascular dysfunction in overt diabetic cardiomyopathy

doi:10.1016/j.ijcme.2014.08.007

IJC Metabolic & Endocrine

Volume 5, November 2014, Pages 19-23

https://doi.org/10.1016/j.ijcme.2014.08.007 Get rights and content

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Abstract

Background

Diabetic cardiomyopathy is characterized by microvascular disease and interstitial fibrosis, which lead to progressive heart failure; however, its pathogenesis remains uncertain. Perfusion cardiac magnetic resonance (CMR) has been proven efficient to detect subclinical myocardial perfusion reserve abnormalities in context of diabetes type 1 in the absence of epicardial coronary artery disease.

Objective

To evaluate myocardial perfusion reserve in patients with advanced cardiomyopathy and type 2 diabetes mellitus but without obstructive coronary artery disease (DM2). We hypothesized that impaired myocardial perfusion reserve deteriorates as systolic dysfunction progresses.

Method and results

Mean myocardial perfusion relative upslope at rest and during hyperaemia (adenosine 140 mg/kg/min) and mean perfusion reserve index (MPRI), were examined in 11 clinically stable DM2 patients (mean (SD) age 67 (8.4) years, range of 54–83 years; NYHA I–II; EF: 37.4 (11.3) %) using perfusion cardiac magnetic resonance (CMR). They were compared against 16 patients with idiopathic cardiomyopathy (mean age: 62 (14.0) years, range of 37–82 years; NYHA I–II; mean EF: 46 (12.3) %) and 10 healthy volunteers with normal ECG and no evidence of cardiac disease (mean age 35 (11.2) years, range of 27–66 years; mean EF: 65 (5.1) %).

DM2 patients had lower hyperemic perfusion relative upslope (0.2 (0.07) v. 0.31 (0.04) p = 0.001) and MPRI (0.736 (0.233) v. 2.35 (0.284), p = 0.001) compared to healthy subjects. Results of DM2 and DCM patients were similar. MPRI in DM2 patents with moderate LV dysfunction was not different from patients with severe dysfunction.

Conclusion

In patients with DM2 myocardial perfusion reserve is markedly decreased, suggestive of microvascular disease. In this small cohort MPRI impairment did not correlate to the LV EF deterioration.

Keywords

Cardiac magnetic resonance

Diabetic cardiomyopathy

Microvascular coronary dysfunction

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^☆: Disclosures: Dr Bratis, Dr Child, Dr Chiribiri and Dr Nagel acknowledge financial support from the Department of Health through the National Institute for Health Research (NIHR) comprehensive Biomedical Research Centre award to Guy's & St Thomas' NHS Foundation Trust in partnership with King's College London and King's College Hospital NHS Foundation Trust. The Division of Imaging Sciences receives also support as the Centre of Excellence in Medical Engineering (funded by the Wellcome Trust and EPSRC; grant number WT 088641/Z/09/Z) as well as the BHF Centre of Excellence (British Heart Foundation award RE/08/03).

^☆☆: Dr Chiribiri receives grant support from Philips Healthcare. Dr. Nagel received significant grant support from Bayer Schering Pharma and Philips Healthcare.

^★: The rest of the authors have no financial activities related to the present article to disclose.

^★★

Author contributions: KB wrote the manuscript and researched data. NC participated in the design of the study and performed the statistical analysis. JT, JN, KA, IF, CS, AC, EN and SM conceived of the study, and participated in its design and coordination and reviewed/edited the manuscript. All authors read and approved the final manuscript.

Available online 1 September 2014