Relationship between HgbA1c and myocardial blood flow reserve in patients with type 2 diabetes mellitus: noninvasive assessment using real-time myocardial perfusion echocardiography

J Diabetes Res. 2014:2014:243518. doi: 10.1155/2014/243518. Epub 2014 Jul 2.

Abstract

To study the relationship between glycosylated hemoglobin (HgbA1c) and myocardial perfusion in type 2 diabetes mellitus (T2DM) patients, we prospectively enrolled 24 patients with known or suspected coronary artery disease (CAD) who underwent adenosine stress by real-time myocardial perfusion echocardiography (RTMPE). HgbA1c was measured at time of RTMPE. Microbubble velocity (β min(-1)), myocardial blood flow (MBF, mL/min/g), and myocardial blood flow reserve (MBFR) were quantified. Quantitative MCE analysis was feasible in all patients (272/384 segments, 71%). Those with HgbA1c > 7.1% had significantly lower βreserve and MBFR than those with HgbA1c ≤ 7.1% (P < 0.05). In patients with suspected CAD, there was a significant inverse correlation between MBFR and HgbA1c (r = -0.279, P = 0.01); however, in those with known CAD, this relationship was not significant (r = -0.117, P = 0.129). Using a MBFR cutoff value > 2 as normal, HgbA1c > 7.1% significantly increased the risk for abnormal MBFR, (adjusted odds ratio: 1.92, 95% CI: 1.12-3.35, P = 0.02). Optimal glycemic control is associated with preservation of MBFR as determined by RTMPE, in T2DM patients at risk for CAD.

MeSH terms

  • Adenosine
  • Aged
  • Biomarkers / blood
  • Blood Flow Velocity
  • Coronary Artery Disease / diagnostic imaging*
  • Coronary Artery Disease / etiology
  • Coronary Artery Disease / physiopathology
  • Diabetes Mellitus, Type 2 / blood*
  • Diabetes Mellitus, Type 2 / complications
  • Diabetic Angiopathies / diagnostic imaging*
  • Diabetic Angiopathies / etiology
  • Diabetic Angiopathies / physiopathology
  • Echocardiography, Stress*
  • Female
  • Fractional Flow Reserve, Myocardial*
  • Glycated Hemoglobin / analysis*
  • Humans
  • Logistic Models
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Myocardial Perfusion Imaging / methods*
  • Odds Ratio
  • Predictive Value of Tests
  • Prospective Studies
  • Regional Blood Flow
  • Risk Factors
  • Vasodilator Agents / therapeutic use

Substances

  • Biomarkers
  • Glycated Hemoglobin A
  • Vasodilator Agents
  • hemoglobin A1c protein, human
  • Adenosine