Structural alterations of the coronary arterial wall are associated with myocardial flow heterogeneity in type 2 diabetes mellitus

Schindler, Thomas; Facta, Alvaro D.; Prior, John O.; Cadenas, Jerson; Zhang, Xiao-Li; Li, Yanjie; Sayre, James; Goldin, Jonathan; Schelbert, Heinrich R.

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Title		Structural alterations of the coronary arterial wall are associated with myocardial flow heterogeneity in type 2 diabetes mellitus
Authors		Schindler, Thomas Facta, Alvaro D. Prior, John O. Cadenas, Jerson Zhang, Xiao-Li Li, Yanjie Sayre, James Goldin, Jonathan Schelbert, Heinrich R. show all authors [1 - 9]
Published in		European Journal of Nuclear Medicine and Molecular Imaging. 2009, vol. 36, no. 2, p. 219-229
Abstract		PURPOSE: To determine the relationship between carotid intima-media thickness (IMT), coronary artery calcification (CAC), and myocardial blood flow (MBF) at rest and during vasomotor stress in type 2 diabetes mellitus (DM). METHODS: In 68 individuals, carotid IMT was measured using high-resolution vascular ultrasound, while the presence of CAC was determined with electron beam tomography (EBT). Global and regional MBF was determined in milliliters per gram per minute with (13)N-ammonia and positron emission tomography (PET) at rest, during cold pressor testing (CPT), and during adenosine (ADO) stimulation. RESULTS: There was neither a relationship between carotid IMT and CAC (r = 0.10, p = 0.32) nor between carotid IMT and coronary circulatory function in response to CPT and during ADO (r = -0.18, p = 0.25 and r = 0.10, p = 0.54, respectively). In 33 individuals, EBT detected CAC with a mean Agatston-derived calcium score of 44 +/- 18. There was a significant difference in regional MBFs between territories with and without CAC at rest and during ADO-stimulated hyperemia (0.69 +/- 0.24 vs. 0.74 +/- 0.23 and 1.82 +/- 0.50 vs. 1.95 +/- 0.51 ml/g/min; p ≤ 0.05, respectively) and also during CPT in DM but less pronounced (0.81 +/- 0.24 vs. 0.83 +/- 0.23 ml/g/min; p = ns). The increase in CAC was paralleled with a progressive regional decrease in resting as well as in CPT- and ADO-related MBFs (r = -0.36, p ≤ 0.014; r = -0.46, p ≤ 0.007; and r = -0.33, p ≤ 0.041, respectively). CONCLUSIONS: The absence of any correlation between carotid IMT and coronary circulatory function in type 2 DM suggests different features and stages of early atherosclerosis in the peripheral and coronary circulation. PET-measured MBF heterogeneity at rest and during vasomotor stress may reflect downstream fluid dynamic effects of coronary artery disease (CAD)-related early structural alterations of the arterial wall.
Keywords		Adenosine/pharmacology — Adult — Calcinosis — Carotid Arteries/pathology/physiopathology — Cold Temperature — Coronary Circulation — Coronary Vessels/metabolism/pathology/physiopathology — Diabetes Mellitus, Type 2/physiopathology/radionuclide imaging — Female — Humans — Male — Middle Aged — Positron-Emission Tomography — Rest — Sympathetic Nervous System/drug effects — Vasodilation/drug effects
Identifiers		DOI: 10.1007/s00259-008-0885-z PMID: 18704406
Full text		Article - Limited access to UNIGE Other version: http://www.springerlink.com/content/87078527t7241705/fulltext.pdf
Structures		Faculté de médecine / Section de médecine clinique / Département de médecine interne des spécialités
Research group		Groupe Schindler Thomas (cardiologie) (890)
Citation (ISO format)		SCHINDLER, Thomas et al. Structural alterations of the coronary arterial wall are associated with myocardial flow heterogeneity in type 2 diabetes mellitus. In: European Journal of Nuclear Medicine and Molecular Imaging, 2009, vol. 36, n° 2, p. 219-229. https://archive-ouverte.unige.ch/unige:20083