Postprandial Myocardial Perfusion in Healthy Subjects and in Type 2 Diabetic Patients
- 12 July 2005
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Circulation
- Vol. 112 (2), 179-184
- https://doi.org/10.1161/circulationaha.104.495127
Abstract
Background— In diabetic patients, postprandial hyperglycemia is a more powerful risk factor for cardiovascular disease than fasting hyperglycemia itself. A negative influence of acute hyperglycemia on systemic endothelial function (brachial artery) has been shown. However, myocardial perfusion during postprandial hyperglycemia has not been investigated. Methods and Results— We evaluated the effects of a standardized mixed meal on myocardial perfusion in 20 healthy subjects and 20 consecutive patients with type 2 diabetes mellitus without macrovascular or microvascular complications. Myocardial perfusion was assessed in fasting and postprandial states by myocardial contrast echocardiography. Fasting myocardial flow velocity (β, 0.65±0.27 versus 0.67±0.24; P =NS), myocardial blood volume (MBV; 8.3±1.2 versus 8.4±2; P =NS), and myocardial blood flow (5.4±1.5 versus 5.6±2; P =NS) did not differ between control subjects and diabetic patients. In the postprandial state, β (0.67±0.24 versus 0.92±0.35; P P P P P P postprandial −MBV fasting )/MBV fasting ]×100) were significantly correlated with postprandial glycemia levels in diabetic patients. Conclusions— Postprandial hyperglycemia determines myocardial perfusion defects in type 2 diabetic patients. They are secondary to deterioration in microvascular function causing a decrease in MBV. In diabetic patients without microvascular or macrovascular complications, postprandial myocardial perfusion defects may represent an early marker of the atherogenic process in the coronary circulation; hence, its reversal constitutes a potential goal of treatment.Keywords
This publication has 28 references indexed in Scilit:
- Changes in myocardial blood volume over a wide range of coronary driving pressures: role of capillaries beyond the autoregulatory rangeHeart, 2004
- Myocardial Contrast EchocardiographyCirculation, 2004
- Accuracy of dipyridamole myocardial contrast echocardiography for the detection of residual stenosis of the infarct-related artery and multivessel disease early after acute myocardial infarctionJournal of the American College of Cardiology, 2004
- Evidence for an Independent and Cumulative Effect of Postprandial Hypertriglyceridemia and Hyperglycemia on Endothelial Dysfunction and Oxidative Stress GenerationCirculation, 2002
- Regional myocardial blood flow reserve impairment and metabolic changes suggesting myocardial ischemia in patients with idiopathic dilated cardiomyopathyJournal of the American College of Cardiology, 1999
- Basis for detection of stenosis using venous administration of microbubbles during myocardial contrast echocardiography: bolus or continuous infusion?Journal of the American College of Cardiology, 1998
- The emerging role of post-prandial hyperglycaemic spikes in the pathogenesis of diabetic complicationsDiabetic Medicine, 1998
- The pathogenesis of atherosclerosis: a perspective for the 1990sNature, 1993
- Myocardial contrast echocardiography for the assessment of coronary blood flow reserve: Validation in humansJournal of the American College of Cardiology, 1993
- Neuroendocrine responses to glucose ingestion in man. Specificity, temporal relationships, and quantitative aspectsJCI Insight, 1983