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, Francesco; Galderisi, Maurizio; Mele, Donato; Agricola, Eustachio; Losi, Maria Angela; Mondillo, Sergio; Marino, Paolo

doi:10.1016/j.ijcard.2010.09.044

Cited by 20 publications

(15 citation statements)

References 41 publications

(34 reference statements)

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“…Determinants of microvascular dysfunction in DM, such as hyperglycemia and insulin resistance, and factors including sympathetic overdrive, endothelial dysfunction, and LV concentric remodeling, also subscribe to the development of LV dysfunction . Systolic heart failure may be a further consequence because of impairment of both diastolic properties and coronary microcirculation . Our results supposed that impaired CFR may have negative effect on LV systolic and diastolic functions in patients with diabetes.…”

Section: Discussionmentioning

confidence: 59%

“…This finding is important as it may imply a tendency to enhanced LV preclinical systolic and diastolic dysfunction in subjects with impaired CFR in early stages of diabetes. Previous studies have demonstrated an inverse association between LV diastolic and systolic function and CFR in diabetic patients . In the study of D'Andrea et al., there were significant correlations between CFR, LV global longitudinal strain, and HbA1c levels in patients with diabetes and microvascular angina.…”

Section: Discussionmentioning

confidence: 86%

“…Previous studies have demonstrated an inverse association between LV diastolic and systolic function and CFR in diabetic patients . In the study of D'Andrea et al., there were significant correlations between CFR, LV global longitudinal strain, and HbA1c levels in patients with diabetes and microvascular angina. In that study, the authors reported that microvascular dysfunction in DM may further contribute to the reduced LV systolic and diastolic myocardial function.…”

Section: Discussionmentioning

confidence: 86%

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Coronary Flow Reserve and Myocardial Performance Index in Newly Diagnosed Diabetic Patients

et al. 2013

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Section: Discussionmentioning

confidence: 59%

Section: Discussionmentioning

confidence: 86%

Section: Discussionmentioning

confidence: 86%

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Coronary Flow Reserve and Myocardial Performance Index in Newly Diagnosed Diabetic Patients

et al. 2013

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“…Other studies have demonstrated blunted myocardial blood flow in normal epicardial arteries in response to mental stress suggestive of microvascular dysfunction 16 . Subclinical myocardial dysfunction assessed by TDI has been associated with abnormal coronary flow reserve in patients with hypertension, diabetes and recent acute myocardial infarction 17–19 . This could suggest that lower resting myocardial velocities in patients with a propensity for developing MSIMI may reflect pre-existing microvascular dysfunction.…”

Section: Discussionmentioning

confidence: 99%

Impaired Resting Myocardial Annular Velocities Are Independently Associated With Mental Stress–Induced Ischemia in Coronary Heart Disease

Ersbøll

Enezi

Samad

et al. 2014

JACC: Cardiovascular Imaging

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Structured Abstract Objectives To investigate the association between resting myocardial function as assessed by tissue Doppler myocardial velocities (TDI) and the propensity for developing mental stress induced ischemia (MSIMI). Background Tissue Doppler myocardial velocities detect preclinical cardiac dysfunction and clinical outcome in a range of conditions. However, little is known about the interrelationship between myocardial velocities and the propensity for developing MSIMI versus exercise stress induced myocardial ischemia (ESIMI). Methods Resting annular myocardial TDI velocities were obtained in 225 patients with known coronary heart disease who were subjected to both conventional exercise stress test as well as a battery of 3 mental stress tests. Diastolic early (e′) and late (a′) as well as systolic (s′) velocities were obtained and eas-index, an integrated measure of myocardial velocities, was calculated as e′/(a′ x s′). MSIMI was defined as 1) development or worsening of regional wall motion abnormality, 2) reduction in left ventricular ejection fraction ≥ 8%, and/or 3) ischemic ST-segment changes during one or more of the three mental stress tests. Results A total of 98 (43.7%) out of 225 patients exhibited MSIMI. Patients developing MSIMI had significantly lower s′ (7.0±1.7 vs 7.5±1.2, p=0.016) and a′ (8.9±1.8 vs 10.0±1.9, p<0.001) at baseline whereas e′ did not differ (6.5±1.7 vs. 6.5±1.8, p=0.85). Furthermore, the eas-index was significantly higher (0.11±0.04 vs. 0.09±0.03, p<0.0001).The eas-index remained significantly associated with the propensity for developing MSIMI (Odds ratio per 0.05 unit increase: 1.85; 95%CI: 1.21–2.82, p=0.004) after adjustment of resting LVEF, resting wall motion index score, gender and social circumstances of living. There was no association between resting eas-index and ESIMI. Conclusion MSIMI but not ESIMI is independently associated with resting abnormalities in myocardial systolic and late diastolic velocities as well as the integrated measure of the eas-index in patients with known coronary artery disease.

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“…Systolic strain alteration can exist despite normal diastolic function, indicating that diastolic dysfunction should not be considered the first marker of the preclinical form of diabetic cardiomyopathy [23]. The studies on T2DM also showed both global and regional longitudinal strains were significantly reduced in patients with DM with respect to controls [24]. Galderisi M’s study [25] reported strain rate and strain were significantly lower in diabetics at low-dose and high-dose dobutamine, indicating altered contractile reserve in uncomplicated diabetes.…”

Section: Discussionmentioning

confidence: 99%

Time-course changes in left ventricular myocardial deformation in STZ-induced rabbits on velocity vector imaging

Zeng

Jiang

Zhou

et al. 2014

Cardiovasc Ultrasound

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ObjectivesTo clarify the time-course changes in left ventricular myocardial deformation using velocity vector imaging and to provide insights into our understanding of the cardiac pathophysiology in diabetes mellitus.MethodsThirty New Zealand white rabbits were randomly divided into either the control group (n = 10) or the diabetes mellitus (DM) group (induced with STZ, n = 20). For the myocardial deformation studies, echocardiography and syngo-vector velocity imaging (VVI) were performed at baseline and after 2, 4, 8, and 12 weeks in all of the rabbits. The left ventricular (LV) global longitudinal and circumferential strain and strain rate were measured. For histomorphological study of the heart structure, 2 of the STZ-induced rabbits were killed at 2, 4, 8, and 12 weeks. Routine hematoxylin and eosin staining was performed.ResultsAt 2 weeks, the global longitudinal strain (GLS), systolic strain rate (GLSRs), and diastolic strain rate (GLSRd) were significantly lower in the DM group compared with the control group (-18.16% versus -24.00%, -1.86 s-1 versus -2.49 s-1, 1.93 s-1 versus 2.42 s-1, respectively, P < 0.05), while, compared with the control group, the global circumferential strain (GCS), systolic strain rate (GCSRs), and diastolic strain rate (GCSRd) in the DM group were significantly decreased (-12.77% versus -23.31%, -1.31 s-1 versus -2.20 s-1, 1.41 s-1 versus 2.15 s-1, respectively, P < 0.05) at 8 weeks. With the progression of untreated diabetes, the histoanatomical alterations intensified gradually beginning at 2 weeks.ConclusionsThe progressive impairments in LV myocardial deformation and structure occurred early in diabetic rabbits with normal LV ejection fraction (EF), FS, and E/A. VVI could be used to evaluate subtle cardiac dysfunction in the early phase of DM.

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

Cited by 20 publications

References 41 publications

Coronary Flow Reserve and Myocardial Performance Index in Newly Diagnosed Diabetic Patients

Coronary Flow Reserve and Myocardial Performance Index in Newly Diagnosed Diabetic Patients

Impaired Resting Myocardial Annular Velocities Are Independently Associated With Mental Stress–Induced Ischemia in Coronary Heart Disease

Time-course changes in left ventricular myocardial deformation in STZ-induced rabbits on velocity vector imaging

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