Introduction
Methods
Study population
Dipyridamole testing and MPGS protocols
Echocardiographic protocol
Data analysis and interpretation
Follow up
Statistical analysis
Results
Population
Variable | All patients (n=63) | Diabetic (n=28) | Non-diabetic (n=35) | p-value |
---|---|---|---|---|
Age (yrs) | 70 ±11 | 70±10 | 72±10 |
0.04
|
Male (%) | 37 (59) | 18 (64) | 19 (54) | 0.42 |
BMI (kg/m2) | 26.3 ± 3.9 | 28.1±4.0 | 24.8±3.2 |
0.001
|
SBP (mmHg) | 137 ± 21 | 135±16 | 138±24 | 0.55 |
DBP (mmHg) | 76±11 | 75±12 | 77±11 | 0.64 |
HR (beats/min) | 70 ± 14 | 69±12 | 71±16 | 0.59 |
Dyspnea status (%)
| ||||
NYHA I | 12 (19) | 7 (25) | 5 (14) | 0.83 |
NYHA II | 39 (62) | 16 (57) | 23 (66) | 0.65 |
NYHA III | 12 (19) | 5 (18) | 7 (20) | 0.72 |
Coronary risk factors (%)
| ||||
Hypertension | 45 (71) | 19 (48) | 26 (71) | 0.58 |
Current smoking | 27 (43) | 12 (43) | 15 (43) | 0.99 |
Hypercholesterolemia | 32 (51) | 14 (50) | 18 (51) | 0.91 |
Family history of cardiovascular | 4 (6) | 2 (7) | 2 (5) | 0.82 |
disease | ||||
Previous coronary artery disease (%)
| 26 (41) | 11 (39) | 15 (43) | 0.78 |
Medications (%)
| ||||
ACE inhibitors/ARB | 38 (62) | 16 (57) | 22 (63) | 0.44 |
Beta-blockers | 30 (48) | 12 (43) | 18 (51) | 0.50 |
Calcium antagonists | 25 (40) | 10 (36) | 15 (43) | 0.56 |
Diabetic characteristics
| ||||
Duration of diabetes (yrs) | - | 12.0±8.8 | - | - |
HbA1c (%) | - | 7.0±2.4 | - | - |
Insulin therapy (%) | - | 20 (71) | - | - |
Oral therapy (%) | 12 (43) | |||
Metformin therapy (%) | - | 8 (29) | - | - |
Retinopathy (%) | - | 11 (39) | - | - |
Peripheral arterial disease (%) | - | 15 (54) | - | - |
Supra aortic | - | 6 (21) | - | - |
Lower limb | - | 11 (39) | - | - |
Blood pressure and heart rate during stress
Effects of dipyridamole on strain reserve
Coef. 95% for LSR | ||
---|---|---|
p-value | ||
Baseline characteristics
| ||
Age (yrs) * | −0.49 |
<0.0001
|
Male † | −2.45 | 0.46 |
Female | −2.04 | |
BMI (kg/m2) * | 0.25 |
0.045
|
Dyspnea status †
| ||
NYHA I | −2.33 | 0.98 |
NYHA II | −2.30 | |
NYHA III | −2.17 | |
Coronary risk factors †
| ||
Hypertension | −2.33 | 0.77 |
No hypertension | −2.15 | |
Diabetic | −3.27 |
0.001
|
Non-diabetic | −1.49 | |
Current smoking | −2.92 |
0.045
|
No current smoking | −1.80 | |
Hypercholesterolemia | −2.29 | 0.98 |
No hypercholesterolemia | −2.27 | |
Family history of cardiovascular disease | −0.90 | 0.19 |
No family history of cardiovascular disease | −2.38 | |
Previous coronary artery disease (CAD) †
| ||
CAD | −2.02 | 0.43 |
No CAD | −2.46 | |
Medications †
| ||
ACE inhibitors/ARB | −2.50 | 0.44 |
No ACE inhibitors/ARB | −2.07 | |
Beta-blockers | −1.80 | 0.10 |
No beta-blockers | −2.72 | |
Calcium antagonists | −2.00 | 0.41 |
No calcium antagonists | −2.47 |
Multivariate analysis | ||||
---|---|---|---|---|
Coef. [95% CI] | p-value | Coef. [95% CI] | p-value | |
Age |
−0.10 [−0.14 – -0.05]
|
<0.0001
|
−0.08 [−0.13 – -0.04]
|
0.001
|
Gender (Male) | 0.42 [−0.71 – 1.54] | 0.46 | ||
BMI |
0.14 [0.01 – 0.28]
|
0.045
| ||
Hypertension | 0.18 [−1.05 – 1.41] | 0,77 | ||
Diabetic |
1.79 [0.77 – 2.81]
|
0.001
|
1.33 [0.36 – 2.30]
|
0.008
|
Current smoking |
1.11 [0.02 – 2.20]
|
0.045
| ||
Hypercholesterolemia | 0.02 [−1.09 – 1.13] | 0.98 | ||
Family history of cardiovascular disease | −1.48 [−3.72 – 0.77] | 0.19 | ||
ACE inhibitors/ARB | 0.44 [−0.70 – 1.57] | 0.44 | ||
Beta-blockers | −0.92 [−2.01 – 0.17] | 0.10 | ||
Calcium antagonists | −0.47 [−1.60 – 0.66] | 0.41 | ||
Previous CAD | −0.44 [−1.57 – 0.68] | 0.43 |
Echocardiographic parameters | All patients (n=63) | Diabetic (n=28) | Non-diabetic (n=35) |
p-value
|
---|---|---|---|---|
Rest
| ||||
LVEF (%) | 50.7±14.4 | 49.8±13.0 | 51.4±15.5 |
0.66
|
EDV (ml) | 103.7±46.9 | 106.7±46.6 | 101.2±47.6 |
0.65
|
ESV (ml) | 53.7±39.4 | 56.6±36.7 | 51.3±41.8 |
0.60
|
TVI LVOT (cm) | 22.7±6.0 | 19.3±5.0 | 19.3±5.5 |
0.96
|
GLS (%) | −14.5±4.2 | −13.9±3.7 | −15.0±4.5 |
0.30
|
Longitudinal Strain rate (s-1) | −1.19±0.35 | −1.15±0.26 | −1.22±0.40 |
0.43
|
E (cm.s-1) | 77±25 | 78±26 | 75±25 |
0.60
|
A (cm.s-1) | 81±29 | 79±28 | 82±29 |
0.77
|
E/A (cm.s-1) | 1.07±0.58 | 1.14±0.57 | 1.01±0.59 |
0.41
|
DT (s) | 205±86 | 197±88 | 210±85 |
0.56
|
Stress
| ||||
LVEF (%) | 54.6±13.9 | 54.3±14.0 | 54.9±13.9 |
0.89
|
EDV (ml) | 98.8±41.6 | 98.8±36.3 | 98.9±45.9 |
0.99
|
ESV (ml) | 48.8±35.6 | 48.6±31.6 | 48.9±38.9 |
0.97
|
TVI LVOT (cm) | 22.7±6.0 | 23.0±5.0 | 22.5±6.8 |
0.76
|
GLS (%) | −16.8±4.5 | −17.2±4.2 | −16.5±4.8 |
0.55
|
Longitudinal Strain rate (s-1) | −1.34±0.44 | −1.33±0.52 | −1.35±0.37 |
0.86
|
E (cm.s-1) | 84±23 | 83±23 | 85±23 |
0.75
|
A (cm.s-1) | 89±33 | 88±32 | 89±35 |
0.85
|
E/A (cm.s-1) | 1.13±0.77 | 1.15±0.61 | 1.10±0.89 |
0.83
|
DT (s) | 179±73 | 177±76 | 180±71 |
0.87
|
∆ (stress – rest) | ||||
∆ LVEF (%) | 3.9±8.4 | 4.6±9.8 | 3.5±7.2 |
0.60
|
∆ EDV (ml) | −4.8±25.3 | −7.9±30.0 | −2.3±20.9 |
0.39
|
∆ ESV (ml) | −4.9±20.5 | −8.0±24.1 | −2.4±17.0 |
0.28
|
∆ TVI LVOT (cm) | 3.4±2.5 | 3.7±2.6 | 3.2±2.3 |
0.39
|
LSR (%) | −2.28±2.19 | −3.27±1.93 | −1.49±2.08 |
0.001
|
LSRR (s-1) | −0.15±0.34 | −0.17±0.43 | −0.12±0.26 |
0.57
|
Prognosis and follow-up
Univariate analysis | Multivariate analysis | |||
---|---|---|---|---|
HR [95% CI] |
p-value
| HR [95% CI] |
p-value
| |
Rest
| ||||
LVEF (%) | 0.889 [0.821 - 0.964] |
0.004
| ||
EDV (ml) | 1.019 [1.007 - 1.031] |
0.002
| ||
ESV (ml) | 1.020 [1.007 - 1.033] |
0.002
| ||
GLS (%) | 1.335 [1.091 – 1.633] |
0.005
| ||
Stress
| ||||
LVEF (%) | 0.898 [0.839 - 0.960] |
0.002
| ||
EDV (ml) | 1.026 [1.012 - 1.040] |
<0.0001
| ||
ESV (ml) | 1.034 [1.017 - 1.051] |
<0.0001
| 1.047 [1.018 - 1.075] |
0.001
|
GLS (%) | 1.481 [1.155 - 1.899] |
0.002
| ||
∆ (stress – rest) | ||||
∆ LVEF (%) | 0.962 [0.874 - 1.059] |
0.430
| ||
∆ EDV (ml) | 1.003 [0.970 - 1.037] |
0.862
| ||
∆ ESV (ml) | 1.044 [1.006 - 1.084] |
0.022
| 1.065 [1.019 - 1.113] |
0.005
|
LSR (%) | 1.395 [0.973 – 2.001] |
0.070
| ||
LSR > 0 | 6.012 [1.211 - 29.856] |
0.028
| 15.493 [1.419 - 169.182] |
0.025
|