Assante Roberta, Acampa Wanda, Zampella Emilia, Arumugam Parthiban, Nappi Carmela, Gaudieri Valeria, Panico Mariarosaria, Magliulo Mario, Tonge Christine M, Petretta Mario, Cuocolo Alberto
Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy.
Institute of Biostructure and Bioimaging, National Council of Research, Naples, Italy.
Eur J Nucl Med Mol Imaging. 2017 Jul;44(7):1129-1135. doi: 10.1007/s00259-017-3671-y. Epub 2017 Mar 14.
To assess the relationship between coronary atherosclerotic burden and vascular function in diabetic and nondiabetic patients after balancing for coronary risk factors.
We studied 672 patients without overt coronary artery disease and normal myocardial perfusion on stress Rb PET/CT imaging. To account for differences in baseline characteristics between diabetic patients and nondiabetic patients, we created a propensity score-matched cohort considering clinical variables and coronary risk factors.
Before matching, diabetic patients had higher coronary artery calcium (CAC) scores (p < 0.001) and lower coronary flow reserve (CFR; p < 0.001) than nondiabetic patients. After matching, CAC scores were comparable between diabetic and nondiabetic patients, but diabetic patients still had lower hyperaemic myocardial blood flow (p < 0.001) and CFR (p < 0.05). Patients were categorized by ln(CAC score) quartiles. There was a decrease in CFR with increasing CAC score quartile in both diabetic patients (p for trend < 0.01) and nondiabetic patients (p for trend < 0.005). Diabetes was associated with lower CFR across quartile categories (p < 0.002). In a multivariable linear regression analysis, CAC score was inversely related to CFR in both diabetic patients (p < 0.05) and nondiabetic patients (p < 0.001).
Diabetic patients had higher CAC scores than nondiabetic patients, but the difference disappeared when clinical characteristics were taken into account. Of note, diabetic patients also had lower CFR regardless of CAC score than nondiabetic patients after matching. Thus, coronary atherosclerotic burden and vascular function have to be seen as two different entities.
在平衡冠状动脉危险因素后，评估糖尿病患者和非糖尿病患者冠状动脉粥样硬化负荷与血管功能之间的关系。
我们研究了672例在负荷Rb PET/CT成像上无明显冠状动脉疾病且心肌灌注正常的患者。为了考虑糖尿病患者和非糖尿病患者基线特征的差异，我们根据临床变量和冠状动脉危险因素创建了一个倾向评分匹配队列。
匹配前，糖尿病患者的冠状动脉钙化（CAC）评分高于非糖尿病患者（p < 0.001），冠状动脉血流储备（CFR）低于非糖尿病患者（p < 0.001）。匹配后，糖尿病患者和非糖尿病患者的CAC评分相当，但糖尿病患者的充血性心肌血流量仍较低（p < 0.001），CFR也较低（p < 0.05）。患者按ln（CAC评分）四分位数进行分类。在糖尿病患者（趋势p < 0.01）和非糖尿病患者（趋势p < 0.005）中，CFR均随着CAC评分四分位数的增加而降低。在各四分位数类别中，糖尿病与较低的CFR相关（p < 0.002）。在多变量线性回归分析中，CAC评分在糖尿病患者（p < 0.05）和非糖尿病患者（p < 0.001）中均与CFR呈负相关。
糖尿病患者的CAC评分高于非糖尿病患者，但在考虑临床特征后这种差异消失。值得注意的是，匹配后，无论CAC评分如何，糖尿病患者的CFR仍低于非糖尿病患者。因此，冠状动脉粥样硬化负荷和血管功能必须被视为两个不同的实体。
