Hyperglycemia Rather Than Insulin Resistance Is Related to Reduced Coronary Flow Reserve in NIDDM

Abstract

To clarify if coronary flow reserve (CFR) is related to insulin resistance or hyperglycemia in normotensive NIDDM, myocardial blood flow (MBF) at baseline and during dipyridamole loading were measured with 13N-ammonia positron-emission tomography. CFR was significantly reduced in NIDDM patients compared with age-matched control subjects. CFR in patients with well-controlled NIDDM was significantly higher than in those with poorly controlled NIDDM, whereas insulin resistance was comparable between the two groups. CFR in NIDDM patients was not related to the degree of insulin resistance. CFR correlated significantly with average fasting glucose concentration and average HbA1c, but not with insulin resistance, age, lipid parameters, or blood pressure. In conclusion, control of blood glucose concentration rather than insulin resistance is most likely related to the reduced CFR in NIDDM.

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“…The deterioration of CFR allows identification of severe stenoses of epicardial coronary arteries and microvascular disturbances due to endothelial dysfunction with high sensitivity. Previous investigations in diabetics demonstrated an inverse correlation between the duration and elevation of blood sugar levels and impairment of CFR [19,20]. Not surprisingly, patients of this study who had suboptimally adjusted long-standing diabetes exhibited a CFR which was uniformly in the lower normal range, indicating the presence of a microcirculatory disturbance.…”

Coronary Microvascular Reactivity to Adenosine Predicts Adverse Outcome in Women Evaluated for Suspected Ischemia

“…Finally, reduced MBF reserve in patients with hypertrophic(9) or dilated cardiomyopathy(29) has predictive value for prognosis. Thus the overall topic of coronary microvascular dysfunction and its clinical implications has increasing interest(11–13,15–18,38–43). …”

Sildenafil verändert nicht die koronare Flussreserve bei Diabetikern mit erektiler Dysfunktion

“…Hämodynamisch relevante Koronararterienstenosen können mit einer hohen Sensitivität erkannt werden und lassen sich von Einschränkungen der CFR durch eine nicht hämodynamisch relevanten Koronararterienstenose oder eine Mikrozirkulationsstörung abgrenzen (3,15). Übereinstimmend mit früheren Untersuchungen fanden wir, dass die CFR bei Diabetikern häufig im unteren Normbereich liegt und die Höhe der Hyperglykämie mit der CFR invers korreliert (17,25 …”