Flow-mediated-paradoxical vasoconstriction is independently associated with asymptomatic myocardial ischemia and coronary artery disease in type 2 diabetic patients

Cardiovascular Diabetology

Original Investigation

Hélène Rousseau¹  Eric Vicaut¹  Christelle Laguillier-Morizot²  Alain Nitenberg³  Isabelle Pham⁴  Paul Valensi⁵  Emmanuel Cosson⁶  Minh Tuan Nguyen⁶ 

[1] AP-HP, Unit of Clinical Research, Lariboisière Hospital, Paris 7 University, Paris, France;Department of Biochemistry, AP-HP, Jean Verdier Hospital, Bondy, France;Department of Clinical Physiology, AP-HP, Jean Verdier Hospital, Bondy, France;Department of Clinical Physiology, AP-HP, Jean Verdier Hospital, Bondy, France;Paris 13 University, Sorbonne Paris Cité, UFR SMBH, EA 2363 « Réponses cellulaires et fonctionnelles à l’hypoxie », Bobigny, France;Department of Endocrinology-Diabetology-Nutrition, AP-HP, Jean Verdier Hospital, and Paris 13 University, CRNH-IdF, CINFO, Avenue du 14 juillet, Hôpital Jean Verdier, 93143, Bondy Cedex, France;Department of Endocrinology-Diabetology-Nutrition, AP-HP, Jean Verdier Hospital, and Paris 13 University, CRNH-IdF, CINFO, Avenue du 14 juillet, Hôpital Jean Verdier, 93143, Bondy Cedex, France;Sorbonne Paris Cité, UMR U557 INSERM/U11125 INRA/CNAM/Université Paris13, Unité de Recherche Epidémiologique Nutritionnelle, Bobigny, France;

关键词: Silent myocardial ischemia;    Flow-mediated dilation;    Asymptomatic coronary artery disease;    Diabetes;   

DOI  :  10.1186/1475-2840-13-20

 received in 2013-10-17, accepted in 2013-12-31,  发布年份 2014

来源: Springer

【 摘 要 】

BackgroundTo investigate whether flow-mediated dilation (FMD) impairment, which precedes overt atherosclerosis, is associated with silent myocardial ischemia (SMI) and asymptomatic coronary artery disease (CAD) in type 2 diabetes.MethodsForearm FMD was measured by ultrasonography in 25 healthy control, 30 non-diabetic overweight or obese patients and 118 asymptomatic type 2 diabetic patients with a high cardiovascular risk profile. SMI (abnormal stress myocardial scintiscan and/or stress dobutamine echocardiogram) and CAD (coronary angiography in the patients with SMI) were assessed in the diabetic cohort.ResultsFMD was lower in diabetic patients (median 0.61% (upper limits of first and third quartiles -1.22;3.2)) than in healthy controls (3.95% (1.43;5.25), p < 0.01) and overweight/obese patients (4.25% (1.74;5.56), p < 0.01). SMI was present in 60 diabetic patients, including 21 subjects with CAD. FMD was lower in patients with SMI than in those without (0.12% (-2.3;1.58) vs 1.64% (0;3.69), p < 0.01), with a higher prevalence of paradoxical vasoconstriction (50.0% vs 29.3%, p < 0.05). FMD was also lower in patients with than without CAD (-1.22% (-2.5;1) vs 1.13% (-0.4;3.28), p < 0.01; paradoxical vasoconstriction 61.9% vs 34.4%, p < 0.05). Logistic regression analyses considering the parameters predicting SMI or CAD in univariate analyses with a p value <0.10 showed that paradoxical vasoconstriction (odds ratio 2.7 [95% confidence interval 1.2-5.9], p < 0.05) and nephropathy (OR 2.6 [1.2-5.7], p < 0.05) were independently associated with SMI; and only paradoxical vasoconstriction (OR 3.1 [1.2-8.2], p < 0.05) with CAD. The negative predictive value of paradoxical vasoconstriction to detect CAD was 88.7%.ConclusionsIn diabetic patients, FMD was independently associated with SMI and asymptomatic CAD.Trial registrationTrial registration number NCT00685984.

【 授权许可】

Unknown   
© Nguyen et al.; licensee BioMed Central Ltd. 2014. This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.