Abstract
BackgroundLeft 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.MethodsWe 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 0.14 mg/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 >2.0 mg/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.ResultsWe 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′.ConclusionsCFR 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.
Highlights
Left ventricular (LV) diastolic dysfunction is known as an early marker of myocardial alterations in patients with diabetes
Small vessel disease that causes diabetic retinopathy represents an increased risk of heart failure that is independent of known risk factors [13], since diabetic retinopathy is significantly associated with LV diastolic dysfunction [14]
The final study population consisted of 67 patients (50 male; mean age, 57 ± 12 years) with type 2 diabetes who met the inclusion criteria (Fig. 2)
Summary
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. Small vessel disease that causes diabetic retinopathy represents an increased risk of heart failure that is independent of known risk factors [13], since diabetic retinopathy is significantly associated with LV diastolic dysfunction [14]. CFR, the ratio of hyperemic to basal coronary blood flow velocity, is a physiological parameter that reflects coronary microvascular function in the absence of large vessel stenosis [16], and many reports have described the utility of measuring CFR by noninvasive transthoracic Doppler echocardiography in various diseases including diabetes [17–21]. We tested the hypothesis that CFR assessed by transthoracic echocardiography is associated with LV diastolic function in patients with type 2 diabetes without a history of heart failure
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