Nguyen Minh Tuan, Pham Isabelle, Valensi Paul, Rousseau Hélène, Vicaut Eric, Laguillier-Morizot Christelle, Nitenberg Alain, Cosson Emmanuel
AP-HP, Jean Verdier Hospital, Department of Endocrinology-Diabetology-Nutrition and Paris 13 University, CRNH-IdF, CINFO, Avenue du 14 juillet, Hôpital Jean Verdier, 93143, Bondy Cedex, France.
Cardiovasc Diabetol. 2014 Jan 15;13:20. doi: 10.1186/1475-2840-13-20.
To investigate whether flow-mediated dilation (FMD) impairment, which precedes overt atherosclerosis, is associated with silent myocardial ischemia (SMI) and asymptomatic coronary artery disease (CAD) in type 2 diabetes.
Forearm FMD was measured by ultrasonography in 25 healthy control, 30 non-diabetic overweight or obese patients and 118 asymptomatic type 2 diabetic patients with a high cardiovascular risk profile. SMI (abnormal stress myocardial scintiscan and/or stress dobutamine echocardiogram) and CAD (coronary angiography in the patients with SMI) were assessed in the diabetic cohort.
FMD was lower in diabetic patients (median 0.61% (upper limits of first and third quartiles -1.22;3.2)) than in healthy controls (3.95% (1.43;5.25), p < 0.01) and overweight/obese patients (4.25% (1.74;5.56), p < 0.01). SMI was present in 60 diabetic patients, including 21 subjects with CAD. FMD was lower in patients with SMI than in those without (0.12% (-2.3;1.58) vs 1.64% (0;3.69), p < 0.01), with a higher prevalence of paradoxical vasoconstriction (50.0% vs 29.3%, p < 0.05). FMD was also lower in patients with than without CAD (-1.22% (-2.5;1) vs 1.13% (-0.4;3.28), p < 0.01; paradoxical vasoconstriction 61.9% vs 34.4%, p < 0.05). Logistic regression analyses considering the parameters predicting SMI or CAD in univariate analyses with a p value <0.10 showed that paradoxical vasoconstriction (odds ratio 2.7 [95% confidence interval 1.2-5.9], p < 0.05) and nephropathy (OR 2.6 [1.2-5.7], p < 0.05) were independently associated with SMI; and only paradoxical vasoconstriction (OR 3.1 [1.2-8.2], p < 0.05) with CAD. The negative predictive value of paradoxical vasoconstriction to detect CAD was 88.7%.
In diabetic patients, FMD was independently associated with SMI and asymptomatic CAD.
Trial registration number NCT00685984.
探讨在2型糖尿病中，先于明显动脉粥样硬化出现的血流介导的血管舒张功能（FMD）受损是否与无症状心肌缺血（SMI）及无症状冠状动脉疾病（CAD）相关。
采用超声检查测量25名健康对照者、30名非糖尿病超重或肥胖患者以及118名具有高心血管疾病风险的无症状2型糖尿病患者的前臂FMD。对糖尿病队列中的患者评估SMI（异常的负荷心肌闪烁扫描和/或负荷多巴酚丁胺超声心动图）及CAD（对有SMI的患者进行冠状动脉造影）。
糖尿病患者的FMD（中位数0.61%（第一和第三四分位数上限-1.22；3.2））低于健康对照者（3.95%（1.43；5.25），p<0.01）及超重/肥胖患者（4.25%（1.74；5.56），p<0.01）。60名糖尿病患者存在SMI，其中21名患有CAD。有SMI的患者FMD低于无SMI的患者（0.12%（-2.3；1.58）对1.64%（0；3.69），p<0.01），反常血管收缩的发生率更高（50.0%对29.3%，p<0.05）。有CAD的患者FMD也低于无CAD的患者（-1.22%（-2.5；1）对1.13%（-0.4；3.28），p<0.01；反常血管收缩61.9%对34.4%，p<0.05）。在单因素分析中p值<0.10的预测SMI或CAD的参数进行的逻辑回归分析显示，反常血管收缩（比值比2.7[95%置信区间1.2 - 5.9]，p<0.05）和肾病（比值比2.6[1.2 - 5.7]，p<0.05）与SMI独立相关；而只有反常血管收缩（比值比3.1[1.2 - 8.2]，p<0.05）与CAD相关。反常血管收缩检测CAD的阴性预测值为88.7%。
在糖尿病患者中，FMD与SMI及无症状CAD独立相关。
试验注册号NCT00685984。
