Value of peripheral vascular endothelial function in the detection of relative myocardial ischemia in asymptomatic type 2 diabetic patients who underwent myocardial perfusion imaging.
BACKGROUND
Endothelial dysfunction precedes overt atherosclerosis and is present in patients with type 2 diabetes mellitus (T2DM). Myocardial perfusion imaging (MPI) is an effective method of detection of coronary artery disease (CAD); however, the relationship between endothelial function and MPI in asymptomatic patients with T2DM has not been examined.


RESULTS
This study used a subset of the population from the Detection of Ischemia in Asymptomatic Diabetics (DIAD) study. Endothelium-dependent vasodilation (EDV) and endothelium-independent vasodilation (EIV) were measured by use of brachial artery ultrasonography in 75 asymptomatic patients with T2DM (56 men; mean age, 58.6 +/- 6.4 years; mean duration of diabetes, 8.4 +/- 7.5 years) who underwent adenosine MPI. Of the patients, 15 (20%) had evidence of relative ischemia (MPI(+)) whereas 60 (80%) had a normal study (MPI(-)). Both EDV (3.5% +/- 3.7% vs 4.5% +/- 6.6%, P = not significant) and EIV (15.1% +/- 7.5% vs 16.8% +/- 8.4%, P = not significant) were similar in the 2 groups. On the basis of a receiver-operator analysis, an EDV response of 8% was selected as a cut point, with a negative predictive value of 93% (13/14 subjects with EDV >or=8% were MPI(-)).


CONCLUSIONS
Endothelial function in asymptomatic patients with T2DM is not associated with the presence of relative myocardial ischemia by MPI; however, an EDV of 8% or greater has a high negative predictive value for the exclusion of CAD.
Papaioannou
Georgios I
GI
Henry Low Heart Center, Cardiology Division, Hartford Hospital, CT 06102, USA.
Kasapis
Christos
C
Seip
Richard L
RL
Grey
Neil J
NJ
Katten
Deborah
D
Wackers
Frans J Th
FJ
Inzucchi
Silvio E
SE
Engel
Samuel
S
Taylor
Amy
A
Young
Lawrence H
LH
Chyun
Deborah A
DA
Davey
Janice A
JA
Iskandrian
Ami E
AE
Ratner
Robert E
RE
Robinson
Evelyn C
EC
Carolan
Stella
S
Heller
Gary V
GV
D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000378:metabolism / Q000473:pathology*; D004730:Endothelium, Vascular / Q000473:pathology*; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D007511:Ischemia / Q000473:pathology; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000150:complications* / Q000473:pathology*; D009206:Myocardium / Q000473:pathology; D005996:Nitroglycerin / Q000494:pharmacology; D010477:Perfusion; D014665:Vasodilator Agents / Q000494:pharmacology
D014665:Vasodilator Agents; D005996:Nitroglycerin