title: Coronary flow reserve by contrast enhanced transesophageal coronary sinus Doppler measurements can evaluate diabetic microvascular dysfunction.
abstract: BACKGROUND
  This study was undertaken to investigate whether coronary flow reserve (CFR) using coronary sinus flow (CSF), which can be measured by transesophageal Doppler echocardiography (TEDE), especially when contrast enhanced, is useful in evaluating microvascular dysfunction in patients with diabetes mellitus (DM).
  
  
  RESULTS
  CSF recordings using contrast enhanced TEDE were performed before and after adenosine triphosphate infusion (0.15 mg x kg(-1) x min(-1)) in 16 patients with type 2 DM and diabetic retinopathy and in 13 non-DM patients (control). Coronary angiography revealed normal epicardial coronary arteries. CFR was defined as the ratio of the antegrade flow velocity time integral in hyperemic conditions and basal levels. Clear envelopes of CSF were obtained in all DM patients using contrast-enhanced TEDE. CFR using CSF in the DM group was significantly decreased compared with the control group (1.4+/-0.4 vs 2.1+/-0.5, p<0.01), but there were no significant differences of age, ejection fraction, rate of hypertension and hypercholesterolemia between the 2 groups. Using 1.7 of CFR as the cut-off value, diabetic microvascular dysfunction could be detected with 82% sensitivity and 83% specificity.
  
  
  CONCLUSIONS
  CFR calculated by CSF using contrast-enhanced TEDE may be useful for evaluating diabetic microvascular dysfunction.
authors.affiliation: Division of Cardiology, Osaka Rosai Hospital, Sakai 591-8025, Japan. mnishino@orh.go.jp
authors.forename: Masami
authors.initials: M
authors.lastname: Nishino
authors.forename: Shiro
authors.initials: S
authors.lastname: Hoshida
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Egami
authors.forename: Isao
authors.initials: I
authors.lastname: Kondo
authors.forename: Ryu
authors.initials: R
authors.lastname: Shutta
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Yamaguchi
authors.forename: Kenjiro
authors.initials: K
authors.lastname: Tanaka
authors.forename: Jun
authors.initials: J
authors.lastname: Tanouchi
authors.forename: Masatsugu
authors.initials: M
authors.lastname: Hori
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Yamada
mesh_terms: D000368:Aged; D001794:Blood Pressure / Q000502:physiology; D003287:Contrast Media / Q000008:administration & dosage; D003326:Coronary Circulation; D003331:Coronary Vessels / Q000503:physiopathology*; D003925:Diabetic Angiopathies / Q000503:physiopathology*; D004452:Echocardiography / Q000379:methods; D015150:Echocardiography, Doppler / Q000379:methods*; D017548:Echocardiography, Transesophageal / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008833:Microcirculation / Q000503:physiopathology; D008875:Middle Aged; D011134:Polysaccharides; D011379:Prognosis; D012039:Regional Blood Flow / Q000502:physiology
chemical_list: D003287:Contrast Media; D011134:Polysaccharides; C059891:SHU 508