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Published on: August 17, 2022
Microvascular Myocardial Ischemia in Patients With Diabetes Without Obstructive Coronary Stenosis and Its Association
Yarong Yu1, Wenli Yang1, Xu Dai2
1Department of Radiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Insights
Diabetic patients without obstructive coronary artery disease (CAD) have a high incidence of microvascular myocardial ischemia. This condition is significantly linked to angina symptoms in this population.
Area of Science:
- Cardiology
- Diabetology
- Medical Imaging
Background:
- Microvascular myocardial ischemia is a potential cause of angina in diabetic patients.
- Obstructive coronary artery disease (CAD) is often investigated in patients with angina, but non-obstructive causes are also relevant.
- Diabetes mellitus is a known risk factor for cardiovascular complications, including microvascular dysfunction.
Purpose of the Study:
- To determine the incidence of microvascular myocardial ischemia in diabetic patients without obstructive CAD.
- To explore the relationship between microvascular myocardial ischemia and angina symptoms in this patient group.
- To compare myocardial blood flow (MBF) and extracellular volume (ECV) between diabetic and non-diabetic patients without obstructive CAD.
Main Methods:
- Prospective enrollment of diabetic patients and retrospective inclusion of non-diabetic controls with intermediate-to-high pretest probability of CAD.
- Utilized dynamic computed tomography-myocardial perfusion imaging (CT-MPI) and coronary computed tomography angiography (CCTA) for assessments.
- Quantified coronary stenosis, MBF, and ECV; defined microvascular myocardial ischemia as mean MBF ≤ 100 mL/min/100 mL.
Main Results:
- Diabetic patients without obstructive CAD showed significantly lower mean global MBF (152.8 vs. 170.4 mL/min/100 mL) and higher mean ECV (27.2% vs. 25.8%) compared to controls.
- The incidence of microvascular myocardial ischemia was substantially higher in diabetic patients (36.3%) versus non-diabetic controls (10.3%).
- Microvascular myocardial ischemia was independently associated with angina symptoms in diabetic patients without obstructive CAD (adjusted OR = 3.439).
Conclusions:
- Dynamic CT-MPI combined with CCTA reveals a high prevalence of microvascular myocardial ischemia in diabetic individuals without obstructive CAD.
- Microvascular myocardial ischemia is a significant finding associated with angina in diabetic patients with non-obstructive coronary artery disease.
- These findings highlight the importance of assessing microvascular function in diabetic patients presenting with angina, even in the absence of obstructive CAD.
Objective:
To investigate the incidence of microvascular myocardial ischemia in diabetic patients without obstructive coronary artery disease (CAD) and its relationship with angina.
Materials And Methods:
Diabetic patients and an intermediate-to-high pretest probability of CAD were prospectively enrolled. Non-diabetic patients but with an intermediate-to-high pretest probability of CAD were retrospectively included as controls. The patients underwent dynamic computed tomography-myocardial perfusion imaging (CT-MPI) and coronary computed tomography angiography (CCTA) to quantify coronary stenosis, myocardial blood flow (MBF), and extracellular volume (ECV). The proportion of patients with microvascular myocardial ischemia, defined as any myocardial segment with a mean MBF ≤ of 100 mL/min/100 mL, in patients without obstructive CAD (Coronary Artery Disease-Reporting and Data System [CAD-RADS] grade 0-2 on CCTA) was determined. Various quantitative parameters of the patients with and without diabetes without obstructive CAD were compared. Multivariable analysis was used to determine the association between microvascular myocardial ischemia and angina symptoms in diabetic patients without obstructive CAD.
Results:
One hundred and fifty-two diabetic patients (mean age: 59.7 ± 10.7; 77 males) and 266 non-diabetic patients (62.0 ± 12.3; 167 males) were enrolled; CCTA revealed 113 and 155 patients without obstructive CAD, respectively. For patients without obstructive CAD, the mean global MBF was significantly lower for those with diabetes than for those without (152.8 mL/min/100 mL vs. 170.4 mL/min/100 mL, P < 0.001). The mean ECV was significantly higher for diabetic patients (27.2% vs. 25.8%, P = 0.009). Among the patients without obstructive CAD, the incidence of microvascular myocardial ischemia (36.3% [41/113] vs. 10.3% [16/155], P < 0.001) and interstitial fibrosis (69.9% [79/113] vs. 33.3% [8/24], P = 0.001) were significantly higher in diabetic patients than in the controls. The presence of microvascular myocardial ischemia was independently associated with angina symptoms (adjusted odds ratio = 3.439, P = 0.037) in diabetic patients but without obstructive CAD.
Conclusion:
Dynamic CT-MPI + CCTA revealed a high incidence of microvascular myocardial ischemia in diabetic patients without obstructive CAD. Microvascular myocardial ischemia is strongly associated with angina.
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