Martin Heyn Sørensen1,2, Annemie Stege Bojer1,2, David Andrew Broadbent3,4, Sven Plein5, Per Lav Madsen6,7, Peter Gæde1,2. 1. Department of Cardiology and Endocrinology, Slagelse Hospital, Ingemannsvej 32, 4200 Slagelse, Denmark. 2. Institute of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Campusvej 55, 5230 Odense, Denmark. 3. Department of Medical Physics and Engineering, Leeds Teaching Hospitals NHS Trust, Great George St, LS1 3EX, Leeds, UK. 4. Biomedical Imaging Science Department, University of Leeds, LS2 9JT, Leeds, UK. 5. Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, LS2 9JT, Leeds, UK. 6. Department of Cardiology, Copenhagen University Hospital Herlev-Gentofte, Capital Region of Denmark, Borgmester Ib Juels Vej 1, 2730 Herlev, Denmark. 7. Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen N, Denmark.
Abstract
AIMS: Coronary microvascular disease (CMD) is a known complication in type 2 diabetes mellitus (T2DM). We examined the relationship between diabetic complications, left ventricular (LV) function and structure and myocardial perfusion reserve (MPR) as indicators of CMD in patients with T2DM and control subjects. METHODS AND RESULTS: This was a cross-sectional study of 193 patients with T2DM and 25 controls subjects. Patients were grouped as uncomplicated diabetes (n = 71) and diabetes with complications (albuminuria, retinopathy, and autonomic neuropathy). LV structure, function, adenosine stress, and rest myocardial perfusion were evaluated by cardiovascular magnetic resonance. Echocardiography was used to evaluate diastolic function. Patients with uncomplicated T2DM did not have significantly different LV mass and E/e* but decreased MPR (3.8 ± 1.0 vs. 5.1 ± 1.5, P < 0.05) compared with controls. T2DM patients with albuminuria and retinopathy had decreased MPR (albuminuria: 2.4 ± 0.9 and retinopathy 2.6 ± 0.7 vs. 3.8 ± 1.0, P < 0.05 for both) compared with uncomplicated T2DM patients, along with significantly higher LV mass (149 ± 39 and 147 ± 40 vs. 126 ± 33 g, P < 0.05) and E/e* (8.3 ± 2.8 and 8.1 ± 2.2 vs. 7.0 ± 2.5, P < 0.05). When entered in a multiple regression model, reduced MPR was associated with increasing E/e* and albuminuria and retinopathy were associated with reduced MPR. CONCLUSIONS: Patients with uncomplicated T2DM have reduced MPR compared with control subjects, despite equivalent LV mass and E/e*. T2DM patients with albuminuria or retinopathy have reduced MPR and increased LV mass and E/e* compared with patients with uncomplicated T2DM. E/e* and MPR are significantly associated after adjustment for age, hypertension, and LV mass, suggesting a link between CMD and cardiac diastolic function. CLINICAL TRIAL REGISTRATION: https://www.clinicaltrials.org. Unique identifier: NCT02684331. Published on behalf of the European Society of Cardiology. All rights reserved.
AIMS: Coronary microvascular disease (CMD) is a known complication in type 2 diabetes mellitus (T2DM). We examined the relationship between diabetic complications, left ventricular (LV) function and structure and myocardial perfusion reserve (MPR) as indicators of CMD in patients with T2DM and control subjects. METHODS AND RESULTS: This was a cross-sectional study of 193 patients with T2DM and 25 controls subjects. Patients were grouped as uncomplicated diabetes (n = 71) and diabetes with complications (albuminuria, retinopathy, and autonomic neuropathy). LV structure, function, adenosine stress, and rest myocardial perfusion were evaluated by cardiovascular magnetic resonance. Echocardiography was used to evaluate diastolic function. Patients with uncomplicated T2DM did not have significantly different LV mass and E/e* but decreased MPR (3.8 ± 1.0 vs. 5.1 ± 1.5, P < 0.05) compared with controls. T2DMpatients with albuminuria and retinopathy had decreased MPR (albuminuria: 2.4 ± 0.9 and retinopathy 2.6 ± 0.7 vs. 3.8 ± 1.0, P < 0.05 for both) compared with uncomplicated T2DMpatients, along with significantly higher LV mass (149 ± 39 and 147 ± 40 vs. 126 ± 33 g, P < 0.05) and E/e* (8.3 ± 2.8 and 8.1 ± 2.2 vs. 7.0 ± 2.5, P < 0.05). When entered in a multiple regression model, reduced MPR was associated with increasing E/e* and albuminuria and retinopathy were associated with reduced MPR. CONCLUSIONS:Patients with uncomplicated T2DM have reduced MPR compared with control subjects, despite equivalent LV mass and E/e*. T2DMpatients with albuminuria or retinopathy have reduced MPR and increased LV mass and E/e* compared with patients with uncomplicated T2DM. E/e* and MPR are significantly associated after adjustment for age, hypertension, and LV mass, suggesting a link between CMD and cardiac diastolic function. CLINICAL TRIAL REGISTRATION: https://www.clinicaltrials.org. Unique identifier: NCT02684331. Published on behalf of the European Society of Cardiology. All rights reserved.
Authors: Gaurav S Gulsin; Joseph Henson; Emer M Brady; Jack A Sargeant; Emma G Wilmot; Lavanya Athithan; Zin Z Htike; Anna-Marie Marsh; John D Biglands; Peter Kellman; Kamlesh Khunti; David Webb; Melanie J Davies; Thomas Yates; Gerry P McCann Journal: Diabetes Care Date: 2020-07-17 Impact factor: 19.112
Authors: Martin H Sørensen; Annemie S Bojer; Niklas R Jørgensen; David A Broadbent; Sven Plein; Per L Madsen; Peter Gæde Journal: Cardiovasc Diabetol Date: 2020-09-30 Impact factor: 9.951