Relationship between cardiac microvascular dysfunction measured with 82Rubidium-PET and albuminuria in patients with diabetes mellitus

Abstract

BackgroundAlbuminuria is of one the strongest predictors of cardiovascular disease (CVD) in diabetes. Diabetes is associated with cardiac microvascular dysfunction (CMD), a powerful, independent prognostic factor for cardiac mortality. The aim of this study was to evaluate the relationship between CMD and microvascular complications in patients without known CVD.MethodsIn this monocentric study, myocardial flow reserve (MFR) was measured with cardiac 82Rubidium positron emission tomography (Rb-PET) in 311 patients referred to nuclear medicine department of Bichat University Hospital for screening of coronary artery disease from 2012 to 2014. Patients with hemodynamically relevant stenosis on coronary angiography or myocardial ischemia on Rb-PET were excluded. Among patients with diabetes, MFR values were compared according to the presence of retinopathy and albuminuria.ResultsOverall, 175 patients (118 with type 2 diabetes) were included. MFR was significantly lower in patients with diabetes compared with those without diabetes (2.6 ± 1.1 vs. 3.3 ± 1.7; p < 0.005). In patients with diabetes, MFR decreased progressively in relation to albumin urinary excretion (normoalbuminuria: 2.9 ± 1.1, microalbuminuria: 2.3 ± 1.0, macroalbuminuria: 1.8 ± 0.7; p < 0.0001). MFR was not significantly different in patients with vs. without retinopathy (2.4 ± 1.0 vs. 2.7 ± 1.1, p = 0.07). Microalbuminuria and macroalbuminuria remained strongly associated with impaired MFR after multiple adjustments [odds ratio 2.6 (95% CI 1.1–8.4) and 5.3 (95% CI 1.2–44.7), respectively]. This association was confirmed when analyses were restricted to patients with low levels of coronary calcifications on computed tomography.ConclusionsImpaired MFR was more frequent in patients with diabetes and was strongly associated with the degree of albuminuria suggesting that CMD and albuminuria might share common mechanisms.Electronic supplementary materialThe online version of this article (10.1186/s12933-017-0652-1) contains supplementary material, which is available to authorized users.

Cardiac perfusion, structure, and function in type 2 diabetes mellitus with and without diabetic complications

“…Our findings are consistent with a recent observational study using Positron Emission Tomography by Potier et al 22 who demonstrated that micro-and macroalbuminuria in T2DM were associated with a three-and eight-fold increased risk of impaired MPR respectively, even after adjustment for known cardiovascular confounders. Interestingly, this previous study showed no difference in MPR between control subjects and normoalbuminuric patients with T2DM which contrasts the findings in our study.…”

Coronary microvascular dysfunction is associated with poor glycemic control amongst female diabetics with chest pain and non-obstructive coronary artery disease

“…Both endothelial-dependent and -independent CMD are linked to ischemia [14, 15], and thus CMD could represent the underlying mechanism for angina in diabetics who have non-obstructive CAD at angiography. Studies have also shown that systemic microvascular abnormalities may involve endothelin-1 and are common in patients with microvascular angina [18], while others have shown that impaired myocardial flow reserve, which leads to angina, is frequent in type 2 diabetics, and is strongly associated with the degree of albuminuria [19]. These findings suggest that CMD and albuminuria might share common mechanisms, and underscores the notion that microvascular disease in diabetes is a systemic phenomenon extending beyond ‘known’ microvascular beds such as the kidneys and into the coronary circulation.…”

“…CMD is clinically meaningful as it mediates ischemia leading to angina [14, 15] and is associated with an increased risk of cardiovascular events [16, 17]. Studies have shown that systemic microvascular abnormalities may involve endothelin-1, which is common in patients with microvascular angina [18], while others have shown that impaired myocardial flow reserve is frequent in type 2 diabetics, and is strongly associated with the degree of albuminuria [19]. CMD and albuminuria may therefore share common mechanisms related to the pathogenesis of diabetic micro-vasculopathy.…”

Significance of Microalbuminuria in Predicting Silent Myocardial Ischemia in Patients with Type 2 Diabetes Using Myocardial Perfusion Imaging

“…Increasing diabetes prevalence will lead to increasing the side effects of this disease as well as patient’s morbidity and mortality. Diabetes is accompanied with 2 to 4 times increased risk of the CAD development and progression (14). The mortality resulted from any cause including CAD likely will be more in younger patients who have also higher serum glucose levels and suffer from diabetic nephropathy (15,16).…”

“…Potier et al (14) assessed the correlation between cardiac microvascular dysfunction and microalbuminuria in diabetics with 82 Rubidium-positron-emission tomography scan. In their study, myocardial flow reserve (MFR) was significantly lower in diabetic patients versus non-diabetics.…”