Coronary microvascular dysfunction in patients with diabetes, hypertension and metabolic syndrome

Sucato, Vincenzo; Novo, Giuseppina; Evola, Salvatore; Novo, Salvatore

doi:10.1016/j.ijcard.2015.03.213

Cited by 19 publications

(13 citation statements)

References 6 publications

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“…There is a robust association between T2DM and heart failure, and heart failure is the leading cause of mortality in patients with T2DM [ 5 – 8 ]. Coronary microvascular dysfunction in diabetes is a complex pathophysiological process, which involves structural, functional and metabolic alterations, and has emerged among the potential mechanisms leading to increased incidence of heart failure [ 9 ] and risk of cardiovascular mortality [ 4 , 10 ] in patients with diabetes. Using cardiovascular magnetic resonance (CMR), myocardial perfusion during vasodilator stress has been shown to be impaired in patients with diabetes mellitus (DM) [ 11 – 13 ] and in the absence of epicardial coronary artery stenoses, this finding is indicative of coronary microvascular dysfunction.…”

Section: Introductionmentioning

confidence: 99%

Adenosine stress CMR T1-mapping detects early microvascular dysfunction in patients with type 2 diabetes mellitus without obstructive coronary artery disease

Levelt

Piechnik

Liu

et al. 2016

Journal of Cardiovascular Magnetic Resonance

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BackgroundType 2 diabetes mellitus (T2DM) is associated with coronary microvascular dysfunction in the absence of obstructive coronary artery disease (CAD). Cardiovascular magnetic resonance (CMR) T1-mapping at rest and during adenosine stress can assess coronary vascular reactivity. We hypothesised that the non-contrast T1 response to vasodilator stress will be altered in patients with T2DM without CAD compared to controls due to coronary microvascular dysfunction.MethodsThirty-one patients with T2DM and sixteen matched healthy controls underwent CMR (3 T) for cine, rest and adenosine stress non-contrast T1-mapping (ShMOLLI), first-pass perfusion and late gadolinium enhancement (LGE) imaging. Significant CAD (>50% coronary luminal stenosis) was excluded in all patients by coronary computed tomographic angiography.ResultsAll subjects had normal left ventricular (LV) ejection and LV mass index, with no LGE. Myocardial perfusion reserve index (MPRI) was lower in T2DM than in controls (1.60 ± 0.44 vs 2.01 ± 0.42; p = 0.008). There was no difference in rest native T1 values (p = 0.59). During adenosine stress, T1 values increased significantly in both T2DM patients (from 1196 ± 32 ms to 1244 ± 44 ms, p < 0.001) and controls (from 1194 ± 26 ms to 1273 ± 44 ms, p < 0.001). T2DM patients showed blunted relative stress non-contrast T1 response (T2DM: ΔT1 = 4.1 ± 2.9% vs. controls: ΔT1 = 6.6 ± 2.6%, p = 0.007) due to a blunted maximal T1 during adenosine stress (T2DM 1244 ± 44 ms vs. controls 1273 ± 44 ms, p = 0.045).ConclusionsPatients with well controlled T2DM, even in the absence of arterial hypertension and significant CAD, exhibit blunted maximal non-contrast T1 response during adenosine vasodilatory stress, likely reflecting coronary microvascular dysfunction. Adenosine stress and rest T1 mapping can detect subclinical abnormalities of the coronary microvasculature, without the need for gadolinium contrast agents. CMR may identify early features of the diabetic heart phenotype and subclinical cardiac risk markers in patients with T2DM, providing an opportunity for early therapeutic intervention.

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Section: Introductionmentioning

confidence: 99%

Adenosine stress CMR T1-mapping detects early microvascular dysfunction in patients with type 2 diabetes mellitus without obstructive coronary artery disease

Levelt

Piechnik

Liu

et al. 2016

Journal of Cardiovascular Magnetic Resonance

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“…The vascular endothelium regulates blood vessel function, contributing to the maintenance of their homeostasis. 15 Many factors can directly interact with the endothelium, such as vascular inflammation, activated platelets, coagulation factors, and circulating cells, and in some cases, they can impair its function. 16 Endothelial dysfunction is not only considered as the initial mechanism that occurs in the cascade of events that will lead to atherosclerosis and the development of CAD, but it also plays a pathogenic role in MVA.…”

Section: Biomarkers Of Endothelial Dysfunctionmentioning

confidence: 99%

Biomarkers of Coronary Microvascular Dysfunction in Patients With Microvascular Angina: A Narrative Review

et al. 2021

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The current gold standard for diagnosis of coronary microvascular dysfunction (CMD) in the absence of myocardial diseases, whose clinical manifestation is microvascular angina (MVA), is reactivity testing using adenosine or acetylcholine during coronary angiography. This invasive test can be difficult to perform, expensive, and harmful. The identification of easily obtainable blood biomarkers which reflect the pathophysiology of CMD, characterized by high reliability, precision, accuracy, and accessibility may reduce risks and costs related to invasive procedures and even facilitate the screening and diagnosis of CMD. In this review, we summarized the results of several studies that have investigated the possible relationships between blood biomarkers involved with CMD and MVA. More specifically, we have divided the analyzed biomarkers into 3 different groups, according to the main mechanisms underlying CMD: biomarkers of “endothelial dysfunction,” “vascular inflammation,” and “oxidative stress.” Finally, in the last section of the review, we consider mixed mechanisms and biomarkers which are not included in the 3 major categories mentioned above, but could be involved in the pathogenesis of CMD.

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“…Although the pathophysiological mechanisms are not yet clarified, several studies show the effectiveness of the MedD in preventing the development of PAD especially in young patients 42. …”

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confidence: 99%

Mediterranean diet impact on cardiovascular diseases

Mattioli

Palmiero

Manfrini

et al. 2017

Journal of Cardiovascular Medicine

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: Cardiovascular disease (CVD) accounts for more than 17 million deaths per year worldwide. It has been estimated that the influence of lifestyle on CVD mortality amounts to 13.7% for smoking, 13.2% for poor diet, and 12% for inactive lifestyle. These results deeply impact both the healthy status of individuals and their skills in working. The impact of CVD on productivity loss accounts for the 24% in total costs for CVD management.Mediterranean diet (MedD) can positively impact on natural history of CVD. It is characterized by a relatively high consumption of inexpensive and genuine food such as cereals, vegetables, legumes, nuts, fish, fresh fruits, and olive oil as the principal source of fat, low meat consumption and low-to-moderate consumption of milk, dairy products, and wine.Its effects on cardiovascular health are related to the significant improvements in arterial stiffness. Peripheral artery disease, coronary artery disease, and chronic heart failure are all positively influenced by the MedD. Furthermore, MedD lowers the risk of sudden cardiac death due to arrhythmias.The present narrative review aims to analyze the effects of MedD on CVD.

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Coronary microvascular dysfunction in patients with diabetes, hypertension and metabolic syndrome

Cited by 19 publications

References 6 publications

Adenosine stress CMR T1-mapping detects early microvascular dysfunction in patients with type 2 diabetes mellitus without obstructive coronary artery disease

Adenosine stress CMR T1-mapping detects early microvascular dysfunction in patients with type 2 diabetes mellitus without obstructive coronary artery disease

Biomarkers of Coronary Microvascular Dysfunction in Patients With Microvascular Angina: A Narrative Review

Mediterranean diet impact on cardiovascular diseases

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