title: Increased basal coronary blood flow as a cause of reduced coronary flow reserve in diabetic patients.
abstract: A reduced coronary flow reserve (CFR) has been demonstrated in diabetes, but the underlying mechanisms are unknown. We assessed thermodilution-derived CFR after 5-min intravenous adenosine infusion through a pressure-temperature sensor-tipped wire in 30 coronary arteries without significant lumen reduction in 30 patients: 13 with and 17 without a history of diabetes. We determined CFR as the ratio of basal and hyperemic mean transit times (T(mn)); fractional flow reserve (FFR) as the ratio of distal and proximal pressures at maximal hyperemia to exclude local macrovascular disease; and an index of microvascular resistance (IMR) as the distal coronary pressure at maximal hyperemia divided by the inverse of the hyperemic T(mn). We also assessed insulin resistance by the homeostasis model assessment (HOMA) index. FFR was normal in all investigated arteries. CFR was significantly lower in diabetic vs. nondiabetic patients [median (interquartile range): 2.2 (1.4-3.2) vs. 4.1 (2.7-4.4); P = 0.02]. Basal T(mn) was lower in diabetic vs. nondiabetic subjects [median (interquartile range): 0.53 (0.25-0.71) vs. 0.64 (0.50-1.17); P = 0.04], while hyperemic T(mn) and IMR were similar. We found significant correlations at linear regression analysis between logCFR and the HOMA index (r(2) = 0.35; P = 0.0005) and between basal T(mn) and the HOMA index (r(2) = 0.44; P < 0.0001). In conclusion, compared with nondiabetic subjects, CFR is lower in patients with diabetes and epicardial coronary arteries free of severe stenosis, because of increased basal coronary flow, while hyperemic coronary flow is similar. Basal coronary flow relates to insulin resistance, suggesting a key role of cellular metabolism in the regulation of coronary blood flow.
authors: Department of Cardiology, Misericordia Hospital, Grosseto, Italy.
authors: Andrea
authors: A
authors: Picchi
authors: Ugo
authors: U
authors: Limbruno
authors: Marta
authors: M
authors: Focardi
authors: Bernardo
authors: B
authors: Cortese
authors: Andrea
authors: A
authors: Micheli
authors: Letizia
authors: L
authors: Boschi
authors: Silva
authors: S
authors: Severi
authors: Raffaele
authors: R
authors: De Caterina
mesh_terms: D000241:Adenosine / Q000008:administration & dosage; D000368:Aged; D001794:Blood Pressure; D006328:Cardiac Catheterization; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000503:physiopathology*; D003326:Coronary Circulation; D003925:Diabetic Angiopathies / Q000175:diagnosis / Q000503:physiopathology*; D005260:Female; D006439:Hemodynamics; D006801:Humans; D006940:Hyperemia / Q000503:physiopathology; D007262:Infusions, Intravenous; D007333:Insulin Resistance; D007558:Italy; D016014:Linear Models; D008297:Male; D008833:Microcirculation; D008875:Middle Aged; D013815:Thermodilution; D013997:Time Factors; D014655:Vascular Resistance; D014664:Vasodilation; D014665:Vasodilator Agents / Q000008:administration & dosage
chemical_list: D014665:Vasodilator Agents; D000241:Adenosine