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Updated: May 19, 2026
Modeling and Evaluation of Murine Diabetic Cardiomyopathy Model
Published on: November 29, 2024
Association between coronary vascular dysfunction and cardiac mortality in patients with and without diabetes
Venkatesh L Murthy1, Masanao Naya, Courtney R Foster
1Noninvasive Cardiovascular Imaging Program, Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA.
Insights
Coronary vasodilator dysfunction significantly increases cardiac death risk in diabetics and nondiabetics. Impaired coronary flow reserve (CFR) in diabetics without CAD mirrors risk in nondiabetics with known CAD.
Area of Science:
- Cardiology
- Diabetology
- Medical Imaging
Background:
- Diabetes mellitus is a known risk factor for adverse cardiac outcomes, often considered equivalent to coronary artery disease (CAD).
- Early detection of coronary vascular dysfunction is crucial for understanding increased cardiac risk in diabetic patients.
Purpose of the Study:
- To investigate if coronary vascular dysfunction, assessed by coronary flow reserve (CFR), explains the heightened cardiac risk in diabetic patients compared to nondiabetics.
- To evaluate the incremental prognostic value of CFR in risk stratification for cardiac mortality.
Main Methods:
- Quantification of coronary flow reserve (CFR) using positron emission tomography in 2783 patients (1172 diabetics, 1611 nondiabetics).
- Follow-up for a median of 1.4 years to determine the primary endpoint of cardiac death.
- Statistical analysis to assess the association between CFR, diabetes status, and cardiac mortality, and the added value of CFR to risk models.
Main Results:
- Impaired CFR was associated with a 3.2-fold increase in cardiac death risk for diabetics and a 4.9-fold increase for nondiabetics.
- Adding CFR to clinical and imaging risk models significantly improved risk discrimination in both groups.
- Diabetic patients without CAD but with impaired CFR had cardiac death rates similar to nondiabetic patients with known CAD.
Conclusions:
- Coronary vasodilator dysfunction, indicated by impaired CFR, is a strong independent predictor of cardiac mortality in both diabetic and nondiabetic individuals.
- CFR provides significant incremental risk stratification, particularly useful in identifying high-risk diabetic patients without previously diagnosed CAD.
- Diabetic patients without CAD and preserved CFR exhibit very low cardiac mortality rates, comparable to those without diabetes and normal cardiac function.
Background:
Diabetes mellitus increases the risk of adverse cardiac outcomes and is considered a coronary artery disease (CAD) equivalent. We examined whether coronary vascular dysfunction, an early manifestation of CAD, accounts for increased risk among diabetics compared with nondiabetics.
Methods And Results:
A total of 2783 consecutive patients (1172 diabetics and 1611 nondiabetics) underwent quantification of coronary flow reserve (CFR; CFR=stress divided by rest myocardial blood flow) by positron emission tomography and were followed up for a median of 1.4 years (quartile 1-3, 0.7-3.2 years). The primary end point was cardiac death. Impaired CFR (below the median) was associated with an adjusted 3.2- and 4.9-fold increase in the rate of cardiac death for diabetics and nondiabetics, respectively (P=0.0004). Addition of CFR to clinical and imaging risk models improved risk discrimination for both diabetics and nondiabetics (c index, 0.77-0.79, P=0.04; 0.82-0.85, P=0.03, respectively). Diabetic patients without known CAD with impaired CFR experienced a rate of cardiac death comparable to that for nondiabetic patients with known CAD (2.8%/y versus 2.0%/y; P=0.33). Conversely, diabetics without known CAD and preserved CFR had very low annualized cardiac mortality, which was similar to patients without known CAD or diabetes mellitus and normal stress perfusion and systolic function (0.3%/y versus 0.5%/y; P=0.65).
Conclusions:
Coronary vasodilator dysfunction is a powerful, independent correlate of cardiac mortality among both diabetics and nondiabetics and provides meaningful incremental risk stratification. Among diabetic patients without CAD, those with impaired CFR have event rates comparable to those of patients with prior CAD, whereas those with preserved CFR have event rates comparable to those of nondiabetics.
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