Reduced Myocardial Perfusion Reserve in Type 2 Diabetes Is Caused by Increased Perfusion at Rest and Decreased Maximal Perfusion During Stress
- 1 June 2020
- journal article
- research article
- Published by American Diabetes Association in Diabetes Care
- Vol. 43 (6), 1285-1292
- https://doi.org/10.2337/dc19-2172
Abstract
OBJECTIVE To examine differences in myocardial blood flow (MBF) at rest and during stress between patients with type 2 diabetes and control subjects, and to identify potential predictors of changes in MBF at rest and during stress. RESEARCH DESIGN AND METHODS A cross-sectional study was conducted of 193 patients with type 2 diabetes and 20 age- and sex-matched control subjects. Cardiovascular magnetic resonance was used to evaluate left ventricular structure and function and MBF at rest and during adenosine-induced stress. MBF was derived as the mean of the flow within all segments of a midventricular slice. RESULTS Patients with type 2 diabetes had higher global MBF at rest (0.81 +/- 0.19 mL/min/g) and lower global MBF during stress (2.4 +/- 0.9 mL/min/g) than control subjects (0.61 +/- 0.11 at rest, 3.2 +/- 0.8 mL/min/g under stress; both P < 0.01). Patients with macroalbuminuria had lower MBF during stress (1.6 +/- 0.5 mL/min/g) than did patients with microalbuminuria (2.1 +/- 0.7 mL/min/g; P = 0.04), who in turn had lower MBF during stress than did normoalbuminuric patients (2.7 +/- 0.9 mL/min/g; P < 0.01). Patients with severe retinopathy had lower MBF during stress (1.8 +/- 0.6 mL/min/g) than patients with simplex retinopathy (2.3 +/- 0.7 mL/min/g; P < 0.05) and those who did not have retinopathy (2.6 +/- 1.0 mL/min/g; P < 0.05). Albuminuria and retinopathy were associated with reduced MBF during stress in a multiple regression analysis. Stress-related MBF inversely correlated with myocardial extracellular volume (P < 0.001; R-2 = 0.37), a measure of diffuse myocardial fibrosis. A trend toward lower basal MBF was observed in patients treated with sodium-glucose cotransporter 2 inhibitors (P = 0.07). CONCLUSIONS Patients with type 2 diabetes have higher global MBF at rest and lower maximal MBF during vasodilator-induced stress than control subjects. Reduced MBF during stress is associated with diabetes complications (albuminuria and retinopathy) and is inversely correlated with diffuse myocardial fibrosis.Funding Information
- local research committee at NSR hospital (N/A)
- the regional research committee of Region Zealand (13-000849)
- Hjerteforeningen (16-R107-A6819-22020)
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