The relationship between early left ventricular myocardial alterations and reduced coronary flow reserve in non-insulin-dependent diabetic patients with microvascular angina

Antonello D'Andrea, Stefano Nistri, Francesca Castaldo, Maurizio Galderisi, Donato Mele, Eustachio Agricola, Maria Angela Losi, Sergio Mondillo, Paolo Nicola Marino

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Aims: To evaluate left ventricular (LV) systolic and diastolic myocardial function, and their relation to coronary flow reserve in patients with non-insulin-dependent diabetes mellitus (DM) and microvascular angina. Methods and results: We selected a population of 45 normotensive patients with DM (56.3 ± 8.2 years; 25 males) with LV ejection fraction > 50% and microvascular angina (anginal pain, positive imaging stress test and normal coronary angiography). Thirty-five age- and sex-matched healthy controls were also enrolled. All the patients underwent standard echocardiography, Tissue Doppler (TDI), two-dimensional strain (2DSE) imaging, and coronary flow reserve (CFR) measurement. LV myocardial early diastolic peak velocities (Em) and peak systolic 2DSE were reduced in both interventricular septum (IVS) and LV lateral wall (p <0.01) in DM, as well as CFR (1.89 ± 0.7 vs 2.55 ± 0.56, p <0.0001) compared with controls. By multivariate analysis, the independent determinants of Em were glycated haemoglobin (β coefficient = - 0.36; p <0.01) and age (β = - 0.46, p <0.001), while global longitudinal strain was predicted by glycated haemoglobin (β = 0.48, P <0.001) and by the duration of the disease (β = 0.38, P <0.005). An independent association between LV global longitudinal strain and CFR (β coefficient = - 0.47, p <0.001) in DM patients was also evidenced. Conclusions: TDI, 2DSE and CFR are valuable non-invasive and easy-repeatable tools for detecting LV myocardial and coronary function in DM patients with microvascular angina.

Original languageEnglish
Pages (from-to)250-255
Number of pages6
JournalInternational Journal of Cardiology
Volume154
Issue number3
DOIs
Publication statusPublished - Feb 9 2012

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Microvascular Angina
Diabetes Mellitus
Glycosylated Hemoglobin A
Ventricular Septum
Doppler Echocardiography
Coronary Angiography
Exercise Test
Stroke Volume
Type 2 Diabetes Mellitus
Multivariate Analysis
Pain
Population

Keywords

  • Coronary flow reserve
  • Diabetes mellitus
  • Microvascular angina
  • Tissue Doppler
  • Two-dimensional strain imaging

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

The relationship between early left ventricular myocardial alterations and reduced coronary flow reserve in non-insulin-dependent diabetic patients with microvascular angina. / D'Andrea, Antonello; Nistri, Stefano; Castaldo, Francesca; Galderisi, Maurizio; Mele, Donato; Agricola, Eustachio; Losi, Maria Angela; Mondillo, Sergio; Marino, Paolo Nicola.

In: International Journal of Cardiology, Vol. 154, No. 3, 09.02.2012, p. 250-255.

Research output: Contribution to journalArticle

D'Andrea, Antonello ; Nistri, Stefano ; Castaldo, Francesca ; Galderisi, Maurizio ; Mele, Donato ; Agricola, Eustachio ; Losi, Maria Angela ; Mondillo, Sergio ; Marino, Paolo Nicola. / The relationship between early left ventricular myocardial alterations and reduced coronary flow reserve in non-insulin-dependent diabetic patients with microvascular angina. In: International Journal of Cardiology. 2012 ; Vol. 154, No. 3. pp. 250-255.
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T1 - The relationship between early left ventricular myocardial alterations and reduced coronary flow reserve in non-insulin-dependent diabetic patients with microvascular angina

AU - D'Andrea, Antonello

AU - Nistri, Stefano

AU - Castaldo, Francesca

AU - Galderisi, Maurizio

AU - Mele, Donato

AU - Agricola, Eustachio

AU - Losi, Maria Angela

AU - Mondillo, Sergio

AU - Marino, Paolo Nicola

PY - 2012/2/9

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N2 - Aims: To evaluate left ventricular (LV) systolic and diastolic myocardial function, and their relation to coronary flow reserve in patients with non-insulin-dependent diabetes mellitus (DM) and microvascular angina. Methods and results: We selected a population of 45 normotensive patients with DM (56.3 ± 8.2 years; 25 males) with LV ejection fraction > 50% and microvascular angina (anginal pain, positive imaging stress test and normal coronary angiography). Thirty-five age- and sex-matched healthy controls were also enrolled. All the patients underwent standard echocardiography, Tissue Doppler (TDI), two-dimensional strain (2DSE) imaging, and coronary flow reserve (CFR) measurement. LV myocardial early diastolic peak velocities (Em) and peak systolic 2DSE were reduced in both interventricular septum (IVS) and LV lateral wall (p <0.01) in DM, as well as CFR (1.89 ± 0.7 vs 2.55 ± 0.56, p <0.0001) compared with controls. By multivariate analysis, the independent determinants of Em were glycated haemoglobin (β coefficient = - 0.36; p <0.01) and age (β = - 0.46, p <0.001), while global longitudinal strain was predicted by glycated haemoglobin (β = 0.48, P <0.001) and by the duration of the disease (β = 0.38, P <0.005). An independent association between LV global longitudinal strain and CFR (β coefficient = - 0.47, p <0.001) in DM patients was also evidenced. Conclusions: TDI, 2DSE and CFR are valuable non-invasive and easy-repeatable tools for detecting LV myocardial and coronary function in DM patients with microvascular angina.

AB - Aims: To evaluate left ventricular (LV) systolic and diastolic myocardial function, and their relation to coronary flow reserve in patients with non-insulin-dependent diabetes mellitus (DM) and microvascular angina. Methods and results: We selected a population of 45 normotensive patients with DM (56.3 ± 8.2 years; 25 males) with LV ejection fraction > 50% and microvascular angina (anginal pain, positive imaging stress test and normal coronary angiography). Thirty-five age- and sex-matched healthy controls were also enrolled. All the patients underwent standard echocardiography, Tissue Doppler (TDI), two-dimensional strain (2DSE) imaging, and coronary flow reserve (CFR) measurement. LV myocardial early diastolic peak velocities (Em) and peak systolic 2DSE were reduced in both interventricular septum (IVS) and LV lateral wall (p <0.01) in DM, as well as CFR (1.89 ± 0.7 vs 2.55 ± 0.56, p <0.0001) compared with controls. By multivariate analysis, the independent determinants of Em were glycated haemoglobin (β coefficient = - 0.36; p <0.01) and age (β = - 0.46, p <0.001), while global longitudinal strain was predicted by glycated haemoglobin (β = 0.48, P <0.001) and by the duration of the disease (β = 0.38, P <0.005). An independent association between LV global longitudinal strain and CFR (β coefficient = - 0.47, p <0.001) in DM patients was also evidenced. Conclusions: TDI, 2DSE and CFR are valuable non-invasive and easy-repeatable tools for detecting LV myocardial and coronary function in DM patients with microvascular angina.

KW - Coronary flow reserve

KW - Diabetes mellitus

KW - Microvascular angina

KW - Tissue Doppler

KW - Two-dimensional strain imaging

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