Abstract
BackgroundWe assessed the prognostic value of structural abnormalities and coronary vasodilator function in diabetic patients referred to a PET/CT for suspected coronary artery disease (CAD). MethodsWe studied 451 diabetics and 451 nondiabetics without overt CAD and normal myocardial perfusion. Myocardial blood flow (MBF) was computed from the dynamic rest and stress imaging. Myocardial flow reserve (MFR) was defined as ratio of hyperemic to baseline MBF and was considered reduced when < 2. ResultsDuring a mean follow-up of 44 months 33 events occurred. Annualized event rate (AER) was higher in diabetic than nondiabetic patients (1.4% vs 0.3%, P < .001). Diabetic patients with reduced MFR had higher AER compared to those with preserved MFR (3.3% vs 0.4%, P < .001). At Cox analysis, age, BMI and reduced MFR were independent predictors of events in diabetic patients. Patients with diabetes and reduced MFR had lower event-free survival compared to nondiabetic patients and MFR < 2 (P < .001). Event-free survival was similar in patients with diabetes and normal MFR and those without diabetes and reduced MFR. ConclusionsDiabetic patients with reduced MFR had higher AER and lower event-free survival compared to those with preserved MFR and to nondiabetic patients.
Highlights
Diabetes mellitus is associated with higher cardiovascular mortality compared to general population
Reduced myocardial flow reserve (MFR) is associated with higher rate of cardiac mortality in diabetic patients with and without known coronary artery disease (CAD), demonstrating that probably microvascular dysfunction may be an early manifestation of CAD.[4]
The aim of our study was to evaluate the prognostic value of measures of structural abnormalities and coronary vasodilator function in diabetic patients referred to a positron emission tomography (PET)/computed tomography (CT) study for suspected CAD and showing normal myocardial perfusion
Summary
Diabetes mellitus is associated with higher cardiovascular mortality compared to general population This aspect could be related to correlation of diabetic status with cardiovascular risk factors that may contribute to increased risk for coronary artery disease (CAD).[1] beyond traditional risk factors other mechanisms are involved in the increased cardiovascular risk among patients with diabetes, such as the effect of the disease on endothelial function.[2] In diabetic patients there is an evidence of structural and functional alterations of coronary arteries and diffuse atherosclerosis process, which may improve the prediction of cardiovascular events. The aim of our study was to evaluate the prognostic value of measures of structural abnormalities and coronary vasodilator function in diabetic patients referred to a PET/CT study for suspected CAD and showing normal myocardial perfusion. We assessed the prognostic value of structural abnormalities and coronary vasodilator function in diabetic patients referred to a PET/CT for suspected coronary artery disease (CAD)
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