title: Relationship between vascular stiffness and stress myocardial perfusion imaging in asymptomatic patients with diabetes.
abstract: OBJECTIVE
  Vascular stiffness may potentially be used as a screening tool to identify asymptomatic patients with diabetes with abnormal myocardial perfusion. The purpose of this study was therefore to determine the association between vascular stiffness, measured in term of pulse wave velocity (PWV) and augmentation index (AIx), and abnormal myocardial perfusion imaging (MPI) in asymptomatic patients with diabetes.
  
  
  METHODS
  Prospectively, 160 asymptomatic patients with diabetes (mean age 51 years, 87 men) underwent MPI with adenosine stress. The summed stress score (SSS) was determined in each patient according to a 17-segment and five-point score. Abnormal MPI (SSS ≥ 3) was classified as moderate (SSS 3-7) or severe (SSS ≥ 8) MPI defects. Using applanation tonometry, the carotid-femoral PWV and the radial AIx corrected to 75 beats per minute were determined noninvasively.
  
  
  RESULTS
  MPI was abnormal in 61 patients (38%), with severe MPI defects in 22 patients (14%). Mean PWV increased with deteriorating MPI from 8.4 ± 2.2 m/s in normal MPI to 9.0 ± 2.2 m/s in moderate MPI defects (p = 0.11) and to 11.1 ± 2.5 m/s in severe MPI defects (p < 0.01). Likewise, mean AIx increased from 18.4 ± 13.4% to 19.4 ± 10.7% (p = 0.66) and to 25.4 ± 9.0% (p = 0.03). After adjustment for age and other risk factors, PWV remained a significant predictor of severe MPI defects (p = 0.01, OR 1.50, 95% CI 1.11-2.00), whereas AIx was no longer significant (p = 0.20).
  
  
  CONCLUSIONS
  Vascular stiffness measured by PWV is associated with severe MPI defects in asymptomatic patients with diabetes.
authors.affiliation: Department of Cardiology, C5-P, Leiden University Medical Center, Postbus 9600, 2300 RC, Leiden, The Netherlands.
authors.forename: Cornelis J
authors.initials: CJ
authors.lastname: Roos
authors.forename: Roxana
authors.initials: R
authors.lastname: Djaberi
authors.forename: Joanne D
authors.initials: JD
authors.lastname: Schuijf
authors.forename: Eelco J
authors.initials: EJ
authors.lastname: de Koning
authors.forename: Ton J
authors.initials: TJ
authors.lastname: Rabelink
authors.forename: Jan W
authors.initials: JW
authors.lastname: Smit
authors.forename: Alberto M
authors.initials: AM
authors.lastname: Pereira
authors.forename: Imad
authors.initials: I
authors.lastname: Al Younis
authors.forename: Bernies
authors.initials: B
authors.lastname: van der Hiel
authors.forename: Arthur J
authors.initials: AJ
authors.lastname: Scholte
authors.forename: Jeroen J
authors.initials: JJ
authors.lastname: Bax
authors.forename: J Wouter
authors.initials: JW
authors.lastname: Jukema
mesh_terms: D058070:Asymptomatic Diseases; D001696:Biomechanical Phenomena; D001808:Blood Vessels / Q000473:pathology* / Q000503:physiopathology; D003920:Diabetes Mellitus / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D055595:Mechanical Phenomena; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging; D011446:Prospective Studies; D013312:Stress, Physiological; D015899:Tomography, Emission-Computed, Single-Photon