Uncomplicated diabetes mellitus is equivalent for coronary artery disease: new support from novel angiographic myocardial perfusion-myocardial blush.
BACKGROUND
Diabetes mellitus (DM) is accepted as coronary heart disease equivalent even in the presence of normal coronary artery on coronary angiography. We aimed to evaluate microvascular circulation with novel angiographic perfusion indexes "myocardial blush grade" (MBG) and "myocardial filling time" (MFT) in patients with uncomplicated DM.


METHODS
Among 4563 angiographic studies performed between November 2001 and May 2004, 70 subjects with DM who were normotensive, non-smokers and with normal lipid profiles were recruited into the study. Patients were divided into 2 groups according to angiographic results. DM-1: diabetic normotensive and normolipidemic subjects with normal coronary angiography (n: 30) and DM-2: diabetic subjects with lesions in the left anterior descending artery (LAD) less than 50% (n: 40). Non-diabetic, normotensive and normolipidemic 60 subjects were assigned as the control group. Control group was also divided into 2 groups according to angiographic results Control-1: subjects with normal coronary angiography (n: 30) and ; Control-2: subjects with lesions in the left anterior descending artery (LAD) less than 50% (n: 30). MBG was defined between 0 and 3 according to myocardial dyeing density and wash-out speed with 0 as the least and 3 as the most. MFT was calculated by conversion of the frame count, from the beginning of myocardial blushing till the time with the highest amount of contrast, to milliseconds.


RESULTS
MFT was longer in the group DM-2 when compared with other groups (p<0.0001). MFT was similar in Control-2 and DM-1. MFT was shorter in Control-1 when compared with DM-1 and DM-2 (p<0.0001). MBG was lower in DM-2 when compared with Control-1 and Control-2 (p=0.001). However MBG was similar in DM-1 when compared with Control-1 and Control-2.


CONCLUSIONS
Microvascular function is worse in subjects with both diabetes and coronary artery disease than in non-diabetic subjects with coronary artery disease. The most impressive result of our study is diabetic patients with normal coronary angiography have similar MBG and MFT results with non-diabetic coronary artery disease patients. DM causes microvascular dysfunction even one has normal coronary angiography and this put them in the same risk group with non-diabetic coronary artery patients.
Sari
Ibrahim
I
Soydinc
Serdar
S
Davutoglu
Vedat
V
Sezen
Yusuf
Y
Aksoy
Mehmet
M
D016009:Chi-Square Distribution; D003287:Contrast Media; D017023:Coronary Angiography; D003326:Coronary Circulation; D003327:Coronary Disease / Q000000981:diagnostic imaging*; D003924:Diabetes Mellitus, Type 2; D005260:Female; D006801:Humans; D008297:Male; D008833:Microcirculation / Q000473:pathology*; D008875:Middle Aged; D009206:Myocardium
D003287:Contrast Media