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HbA1c is related to microcirculation blood perfusion in patients with coronary microvascular disease using stress
JingWen Yong1, JinFan Tian1, HuiJuan Zuo2
1Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, China.
Insights
Elevated glycated hemoglobin A1c (HbA1c) increases the risk of myocardial perfusion reserve index (MPRI) ≤1.47 in non-diabetic patients. Early management of HbA1c is crucial for individuals with undiagnosed diabetes to prevent adverse cardiovascular events.
Area of Science:
- Cardiology
- Endocrinology
- Medical Imaging
Background:
- Coronary microvascular disease (CMD) is associated with a significantly higher incidence of major adverse cardiovascular events (MACEs) when the myocardial perfusion reserve index (MPRI) is ≤1.47.
- The relationship between elevated glycated hemoglobin A1c (HbA1c) and the risk of reduced MPRI in both diabetic and non-diabetic individuals requires further investigation.
Purpose of the Study:
- To investigate the association between increased HbA1c levels and the risk of MPRI ≤1.47 in patients with suspected CMD.
- To explore whether HbA1c is an independent risk factor for impaired microcirculation in diabetic and non-diabetic populations.
Main Methods:
- Patients with ischemic symptoms and without obstructive coronary disease were screened, with MPRI assessed via stress perfusion cardiac magnetic resonance (CMR).
- A total of 80 patients were included, categorized into two groups based on MPRI values (<1.47 and >1.47).
- Logistic regression analysis was employed to identify risk factors for CMD, with a specific focus on HbA1c levels.
Main Results:
- CMD patients with MPRI ≤1.47 were older and had higher fasting blood glucose and HbA1c levels compared to those with MPRI >1.47.
- In non-diabetic patients, elevated HbA1c (≥6.0%) was significantly associated with an increased risk of MPRI ≤1.47 (OR=0.219, P=0.010).
- In diabetic patients, HbA1c levels were not significantly associated with the risk of MPRI ≤1.47 (OR=1.043, P=0.952).
Conclusions:
- Elevated HbA1c is a significant risk factor for reduced MPRI (≤1.47) in non-diabetic individuals, indicating an increased risk of MACEs.
- Early management of HbA1c is recommended for patients with undiagnosed diabetes or at risk, to mitigate the potential for impaired coronary microcirculation.
Background:
In coronary microvascular disease (CMD) patients, the incidence of major adverse cardiovascular events (MACEs) in patients with myocardial perfusion reserve index (MPRI) ≤ 1.47 is three times higher than that in MPRI > 1.47. We investigated whether the increase of glycated hemoglobin A1c (HbA1c) could increase the risk of MPRI ≤1.47 in diabetic and non-diabetic patients.
Methods:
From November 2019, patients with ischemic symptoms but without obstructive coronary disease were screened. Use MPRI measured by stress perfusion cardiac magnetic resonance (CMR) to reflect microcirculation blood perfusion, and MPRI <2.5 were included. The patients were divided into two groups based on MPRI was greater or <1.47. The risk factors for CMD were explored using logistic regression analysis.
Results:
A total of 80 patients with an MPRI of 1.69 ± 0.79 were included. CMD patients with an MPRI of ≤1.47(n = 33) were higher than MPRI of >1.47(n = 47) in age, presence of diabetes mellitus, fasting blood glucose levels and HbA1c levels (P < 0.05). In non-diabetic patients, increased HbA1c was associated with the risk of MPRI≤1.47 (OR = 0.017, 95%CI: 0.050-1.107, P = 0.045). Compared with non-diabetic patients with HbA1c < 6.0, non-diabetic patients with HbA1c ≥ 6.0 increased the risk of MPRI of ≤1.47 (OR = 0.219, 95%CI: 0.069-0.697, P = 0.010). In diabetic patients, HbA1c was not associated with the risk of MPRI of ≤1.47 (OR = 1.043, 95%CI: 0.269, 4.044, P = 0.952). And compared with non-diabetic patients with HbA1c <6.0, diabetic patients with HbA1c <6.0 (OR = 0.917, 95%CI: 0.233-3.610, P = 0.901) or ≥6.0 (OR = 0.326, 95%CI: 0.073-1.446, P = 0.140), the risk of MPRI ≤ 1.47 was not further increased.
Conclusions:
In non-diabetic patients, elevated HbA1c is related to MPRI≤1.47(a value increased incidence of MACEs). Therefore, in patients with undiagnosed diabetes, early management of glycosylated hemoglobin is very important.
Trial Registration:
This clinical trial has been registered in the Chinese clinical Trial Registry with an identifier: ChiCTR1900025810.
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