The additional prognostic power of diabetes mellitus on coronary flow reserve in patients with suspected coronary artery disease.
OBJECTIVE
The aim of the present study was to assess the relative prognostic value of coronary flow reserve (CFR) and diabetes mellitus (DM) in patients with suspected coronary artery disease (CAD).


METHODS
We prospectively studied 347 inhospital patients with chest pain. Coronary angiography was performed in 281 patients (81%). All patients underwent a transthoracic echocardiographic study to evaluate left ventricular function and a stress vasodilator transoesophageal echocardiographic study to evaluate simultaneously CFR and the degree of aortic atherosclerosis (AA). The primary outcome of the study was cardiovascular mortality.


RESULTS
During a mean follow-up of 41+/-12 months, 22 patients suffered cardiovascular death. Diabetic patients had a significantly higher AA grade and tended to have a lower CFR and more often significant CAD. Patients with normal CFR had less often significant CAD and tended to have less often DM. Significant univariable predictors of cardiovascular survival were DM, LV end-diastolic diameter, CFR and AA grade. Multivariable regression analysis showed that only CFR (hazard ratio (HR) 2.9, P=0.01) and diabetes (HR 3.1, P=0.01) were independent predictors of cardiovascular survival.


CONCLUSIONS
CFR and DM evaluations offer complementary information during vasodilator stress TEE testing. Patients with reduced CFR (impaired microcirculatory function) and DM have the worst prognosis.
Nemes
Attila
A
2nd Department of Medicine and Cardiology Centre, Medical Faculty, Albert Szent-Györgyi Medical and Pharmaceutical Centre, University of Szeged, H-6720 Szeged, Korányi fasor 6, Hungary. nemes@in2nd.szote.u-szeged.hu
Forster
Tamás
T
Geleijnse
Marcel L
ML
Kutyifa
Valentina
V
Neu
Klára
K
Soliman
Osama I I
OI
Ten Cate
Folkert J
FJ
Csanády
Miklós
M
D000328:Adult; D000368:Aged; D017023:Coronary Angiography; D003326:Coronary Circulation; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology*; D003925:Diabetic Angiopathies / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology*; D017548:Echocardiography, Transesophageal; D005080:Exercise Test; D005500:Follow-Up Studies; D006801:Humans; D007297:Inpatients; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D016019:Survival Analysis; D013997:Time Factors; D014665:Vasodilator Agents
D014665:Vasodilator Agents