Banovic Marko, Brkovic Voin, Nedeljkovic Ivana, Nedeljkovic Milan, Popovic Dejana, Djordjevic-Dikic Ana, Ristic Arsen, Nikolic Srdjan, Beleslin Branko
Departments of Non-Invasive Cardiology and Cardiology Clinic, Clinical Centre of Serbia, Belgrade, Serbia Belgrade Medical School, University of Belgrade, Belgrade, Serbia
Departments of Non-Invasive Cardiology and Cardiology Clinic, Clinical Centre of Serbia, Belgrade, Serbia.
Diab Vasc Dis Res. 2016 May;13(3):220-7. doi: 10.1177/1479164115627107. Epub 2016 Mar 18.
Coronary flow reserve is impaired in asymptomatic patients with aortic stenosis and has a prognostic value. We investigated whether the type II diabetes mellitus additionally impairs microvascular circulation assessed by coronary flow reserve in patients with asymptomatic severe aortic stenosis, normal left ventricular ejection fraction and nonobstructed coronary arteries.
A total of 128 patients, mean age of 66.35 ± 10.51 (58.6% males), with severe aortic stenosis and normal left ventricular ejection fraction were enrolled in this study. Patients with diabetes mellitus, those who were treated for diabetes mellitus or had documentation confirming the diagnosis of diabetes mellitus, were considered. All patients underwent coronary angiography and had no obstructive coronary disease (defined as having no stenosis >50% in diameter), standard transthoracic Doppler-echocardiographic study and adenosine stress transthoracic echocardiography for coronary flow reserve measurement.
Diabetes mellitus was present in 26 patients (20.31%). There was no significant difference in aortic stenosis severity between diabetic and non-diabetic patients [aortic valve area (0.81 ± 0.18 vs 0.85 ± 0.15 cm(2)) and Vmax (4.20 ± 0.57 vs 4.21 ± 0.48 m/s)]. Mean coronary flow reserve in diabetic patients was 1.98 ± 0.48, while mean coronary flow reserve in non-diabetic patients was 2.64 ± 0.54 (p < 0.01). Diabetes mellitus was independent predictor of coronary flow reserve [B = -0.636, 95% confidence interval (-0.916 to -0.368), p < 0.001].
Diabetes mellitus additionally impairs coronary microvascular function in asymptomatic patients with severe aortic stenosis and nonobstructed coronary arteries.
无症状主动脉瓣狭窄患者的冠状动脉血流储备受损，且具有预后价值。我们研究了2型糖尿病是否会进一步损害无症状重度主动脉瓣狭窄、左心室射血分数正常且冠状动脉无阻塞患者的冠状动脉血流储备所评估的微血管循环。
本研究共纳入128例重度主动脉瓣狭窄且左心室射血分数正常的患者，平均年龄为66.35±10.51岁（男性占58.6%）。纳入了患有糖尿病、接受过糖尿病治疗或有确诊糖尿病记录的患者。所有患者均接受冠状动脉造影且无阻塞性冠状动脉疾病（定义为直径狭窄>50%），进行标准经胸多普勒超声心动图检查以及用于测量冠状动脉血流储备的腺苷负荷经胸超声心动图检查。
26例患者（20.31%）患有糖尿病。糖尿病患者与非糖尿病患者的主动脉瓣狭窄严重程度无显著差异[主动脉瓣面积（0.81±0.18 vs 0.85±0.15 cm²）和最大流速（4.20±0.57 vs 4.21±0.48 m/s）]。糖尿病患者的平均冠状动脉血流储备为1.98±0.48，而非糖尿病患者的平均冠状动脉血流储备为2.64±0.54（p<0.01）。糖尿病是冠状动脉血流储备的独立预测因素[B=-0.636，95%置信区间（-0.916至-0.368），p<0.001]。
2型糖尿病会进一步损害无症状重度主动脉瓣狭窄且冠状动脉无阻塞患者的冠状动脉微血管功能。
