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Structural alterations of the coronary arterial wall are associated with myocardial flow heterogeneity in type 2 diabetes mellitus

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

To determine the relationship between carotid intima–media thickness (IMT), coronary artery calcification (CAC), and myocardial blood flow (MBF) at rest and during vasomotor stress in type 2 diabetes mellitus (DM).

Methods

In 68 individuals, carotid IMT was measured using high-resolution vascular ultrasound, while the presence of CAC was determined with electron beam tomography (EBT). Global and regional MBF was determined in milliliters per gram per minute with 13N-ammonia and positron emission tomography (PET) at rest, during cold pressor testing (CPT), and during adenosine (ADO) stimulation.

Results

There was neither a relationship between carotid IMT and CAC (r = 0.10, p = 0.32) nor between carotid IMT and coronary circulatory function in response to CPT and during ADO (r = −0.18, p = 0.25 and r = 0.10, p = 0.54, respectively). In 33 individuals, EBT detected CAC with a mean Agatston-derived calcium score of 44 ± 18. There was a significant difference in regional MBFs between territories with and without CAC at rest and during ADO-stimulated hyperemia (0.69 ± 0.24 vs. 0.74 ± 0.23 and 1.82 ± 0.50 vs. 1.95 ± 0.51 ml/g/min; p ≤ 0.05, respectively) and also during CPT in DM but less pronounced (0.81 ± 0.24 vs. 0.83 ± 0.23 ml/g/min; p = ns). The increase in CAC was paralleled with a progressive regional decrease in resting as well as in CPT- and ADO-related MBFs (r = −0.36, p ≤ 0.014; r = −0.46, p ≤ 0.007; and r = −0.33, p ≤ 0.041, respectively).

Conclusions

The absence of any correlation between carotid IMT and coronary circulatory function in type 2 DM suggests different features and stages of early atherosclerosis in the peripheral and coronary circulation. PET-measured MBF heterogeneity at rest and during vasomotor stress may reflect downstream fluid dynamic effects of coronary artery disease (CAD)-related early structural alterations of the arterial wall.

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Abbreviations

ADO:

adenosine

IMT:

intima–media thickness

CAC:

coronary artery calcification

CCS:

coronary artery calcium score

CPT:

cold pressor test

CVR:

coronary vascular resistance

EBT:

electron beam tomography

HDL:

high-density lipoprotein

LDL:

low-density lipoprotein

MBF:

myocardial blood flow

RPP:

rate–pressure product

PET:

positron emission tomography

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Acknowledgments

This work was supported by Research Grant HL 33177, National Heart, Lung and Blood Institute, Bethesda, MD, USA.

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Authors and Affiliations

  1. Department of Molecular and Medical Pharmacology, Radiological Science, David Geffen School of Medicine, University of California at Los Angeles, 10833 Le Conte Avenue, 23-120 CHS, P.O. Box 173517, Los Angeles, CA, 90095-1735, USA

    Thomas H. Schindler, Alvaro D. Facta, John O. Prior, Jerson Cadenas, Xiao-Li Zhang, James Sayre, Jonathan Goldin & Heinrich R. Schelbert

  2. Department of Internal Medicine, Cardiovascular Center, Nuclear Cardiology, University Hospital of Geneva, Geneva, Switzerland

    Thomas H. Schindler

  3. Atherosclerosis Research Unit, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA

    Yanjie Li

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  1. Thomas H. Schindler
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Correspondence to Heinrich R. Schelbert.

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Schindler, T.H., Facta, A.D., Prior, J.O. et al. Structural alterations of the coronary arterial wall are associated with myocardial flow heterogeneity in type 2 diabetes mellitus. Eur J Nucl Med Mol Imaging 36, 219–229 (2009). https://doi.org/10.1007/s00259-008-0885-z

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  • DOI: https://doi.org/10.1007/s00259-008-0885-z

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