Is there an association between glomerular hyperfiltration and coronary flow velocity reserve in patients with...

Area of Science:

• Cardiology
• Nephrology
• Endocrinology

Background:

• Glomerular hyperfiltration (GHF) is an early indicator of chronic kidney disease (CKD).
• GHF may predict coronary microvascular dysfunction (CMD), characterized by reduced coronary flow velocity reserve (CFVR).
• Women with a history of gestational diabetes (GDM) are at increased risk for both CKD and cardiovascular disease.

Purpose of the Study:

• To assess glomerular filtration rate (GFR) and compare CFVR in patients with a history of GDM.
• To investigate the relationship between GFR levels, metabolic parameters, and CFVR in this population.

Main Methods:

• Patients referred for angina pectoris (excluding positive treadmill tests) with a history of GDM were categorized by GFR: Group 1 (60-89 ml/min), Group 2 (90-119 ml/min), and Group 3 (≥120 ml/min).
• Coronary diastolic peak velocities were measured at baseline and after dipyridamole administration to calculate CFVR.
• Homeostasis model assessment of insulin resistance (HOMA-IR) and HbA1c were analyzed.

Main Results:

• A total of 166 patients were included. HOMA-IR was significantly higher in Group 3 (GHF) compared to Group 2.
• CFVR was lowest in Group 1 (CKD range), highest in Group 2 (normal GFR), and moderately reduced in Group 3 (GHF).
• Multivariate analysis identified HbA1c as an independent predictor of reduced CFVR.

Conclusions:

• In women with a history of GDM, glomerular hyperfiltration is associated with reduced coronary flow velocity reserve.
• Metabolic parameters, including HbA1c and HOMA-IR, are linked to this impaired coronary microvascular function.
• Interventions targeting metabolic health may be crucial for preventing cardiovascular disease in GDM patients.