Suleyman Demirel University, Faculty of Medicine, Cardiology Department, Isparta, Turkey.
Metabolism. 2013 Aug;62(8):1123-30. doi: 10.1016/j.metabol.2013.02.011. Epub 2013 Apr 1.
Coronary flow reserve (CFR) provides independent prognostic information in diabetic patients with known or suspected coronary artery disease. However, there have been no substantial data to evaluate CFR in prediabetics. Accordingly, we aimed to evaluate CFR in subjects with prediabetes using second harmonic transthoracic Doppler echocardiography.
We measured CFR of 65 subjects with prediabetes, 45 patients with overt type 2 diabetes, and 43 sex and age matched normoglycemic healthy subjects with normal glucose tolerance. Ages, gender, existence of hypertension or hypercholesterolemia, smoking status were similar among the groups. CFR was significantly lower in diabetics (2.15 ± 0.39) than in prediabetics (2.39 ± 0.45) and controls (2.75 ± 0.35); in addition, it was significantly lower in prediabetics than controls. Only 2 (5%) of control subjects had abnormal CFR (<2) but 11 (17%) prediabetic subjects and 19 (42%) diabetic patients had abnormal CFR. We found that only age (β=-0.31, P<0.01) and presence of the diabetes (β=-0.57, P<0.01) were significant predictors of lower CFR in a multivariable model that adjusted for other variables. CFR was significantly and inversely correlated with age (r=-0.15, P=0.04), fasting glucose level (r=-0.27, P=0.001), postprandial glucose level (r=0.43, P<0.001), hemoglobin A1C level (r=-0.34, P<0.001), LDL cholesterol level (r=0.22, P=0.009), mitral A velocity (r=-0.27, P=0.001) and Tei index (r=-0.19, P=0.02), whereas mitral E/A ratio, mitral Em (r=0.18, P=0.02), mitral Em/Am ratio (r=0.23, P=0.004) were significantly and positively correlated with CFR.
CFR is impaired in subjects with prediabetics, but this impairment is not as severe as that in diabetics.
在已知或疑似患有冠状动脉疾病的糖尿病患者中，冠状动脉血流储备（CFR）提供独立的预后信息。然而，目前尚无大量数据评估糖尿病前期患者的 CFR。因此，我们旨在使用二次谐波经胸多普勒超声心动图评估糖尿病前期患者的 CFR。
我们测量了 65 例糖尿病前期患者、45 例显性 2 型糖尿病患者和 43 例性别和年龄匹配的糖耐量正常的健康对照者的 CFR。三组的年龄、性别、高血压或高胆固醇血症的存在、吸烟状况相似。糖尿病患者的 CFR（2.15 ± 0.39）明显低于糖尿病前期患者（2.39 ± 0.45）和对照组（2.75 ± 0.35）；此外，糖尿病前期患者的 CFR 明显低于对照组。只有 2 名（5%）对照组患者的 CFR 异常（<2），但 11 名（17%）糖尿病前期患者和 19 名（42%）糖尿病患者的 CFR 异常。我们发现，只有年龄（β=-0.31，P<0.01）和糖尿病的存在（β=-0.57，P<0.01）是多变量模型中 CFR 降低的显著预测因子，该模型调整了其他变量。CFR 与年龄呈显著负相关（r=-0.15，P=0.04），与空腹血糖水平（r=-0.27，P=0.001）、餐后血糖水平（r=0.43，P<0.001）、糖化血红蛋白水平（r=-0.34，P<0.001）、LDL 胆固醇水平（r=0.22，P=0.009）、二尖瓣 A 速度（r=-0.27，P=0.001）和 Tei 指数（r=-0.19，P=0.02）呈显著负相关，而二尖瓣 E/A 比值、二尖瓣 Em（r=0.18，P=0.02）、二尖瓣 Em/Am 比值（r=0.23，P=0.004）与 CFR 呈显著正相关。
糖尿病前期患者的 CFR 受损，但程度不如糖尿病患者严重。
