title: Effects of prediabetes and diabetes on left ventricular and coronary microvascular functions.
abstract: BACKGROUND
  Coronary flow reserve (CFR) provides independent prognostic information in diabetic patients with known or suspected coronary artery disease. However, there have been no substantial data to evaluate CFR in prediabetics. Accordingly, we aimed to evaluate CFR in subjects with prediabetes using second harmonic transthoracic Doppler echocardiography.
  
  
  RESULTS
  We measured CFR of 65 subjects with prediabetes, 45 patients with overt type 2 diabetes, and 43 sex and age matched normoglycemic healthy subjects with normal glucose tolerance. Ages, gender, existence of hypertension or hypercholesterolemia, smoking status were similar among the groups. CFR was significantly lower in diabetics (2.15 ± 0.39) than in prediabetics (2.39 ± 0.45) and controls (2.75 ± 0.35); in addition, it was significantly lower in prediabetics than controls. Only 2 (5%) of control subjects had abnormal CFR (<2) but 11 (17%) prediabetic subjects and 19 (42%) diabetic patients had abnormal CFR. We found that only age (β=-0.31, P<0.01) and presence of the diabetes (β=-0.57, P<0.01) were significant predictors of lower CFR in a multivariable model that adjusted for other variables. CFR was significantly and inversely correlated with age (r=-0.15, P=0.04), fasting glucose level (r=-0.27, P=0.001), postprandial glucose level (r=0.43, P<0.001), hemoglobin A1C level (r=-0.34, P<0.001), LDL cholesterol level (r=0.22, P=0.009), mitral A velocity (r=-0.27, P=0.001) and Tei index (r=-0.19, P=0.02), whereas mitral E/A ratio, mitral Em (r=0.18, P=0.02), mitral Em/Am ratio (r=0.23, P=0.004) were significantly and positively correlated with CFR.
  
  
  CONCLUSIONS
  CFR is impaired in subjects with prediabetics, but this impairment is not as severe as that in diabetics.
authors.affiliation: Suleyman Demirel University, Faculty of Medicine, Cardiology Department, Isparta, Turkey. aydoganer@yahoo.com
authors.forename: Dogan
authors.initials: D
authors.lastname: Erdogan
authors.forename: Habil
authors.initials: H
authors.lastname: Yucel
authors.forename: Bayram Ali
authors.initials: BA
authors.lastname: Uysal
authors.forename: Ismail Hakkı
authors.initials: IH
authors.lastname: Ersoy
authors.forename: Atilla
authors.initials: A
authors.lastname: Icli
authors.forename: Salaheddin
authors.initials: S
authors.lastname: Akcay
authors.forename: Akif
authors.initials: A
authors.lastname: Arslan
authors.forename: Fatih
authors.initials: F
authors.lastname: Aksoy
authors.forename: Mehmet
authors.initials: M
authors.lastname: Ozaydin
authors.forename: M Numan
authors.initials: MN
authors.lastname: Tamer
mesh_terms: D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000378:metabolism; D008078:Cholesterol, LDL / Q000097:blood; D003326:Coronary Circulation / Q000502:physiology*; D003924:Diabetes Mellitus, Type 2 / Q000000981:diagnostic imaging / Q000473:pathology*; D004452:Echocardiography; D005260:Female; D005951:Glucose Tolerance Test; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D008297:Male; D008833:Microcirculation / Q000502:physiology*; D008875:Middle Aged; D008943:Mitral Valve / Q000502:physiology; D011236:Prediabetic State / Q000000981:diagnostic imaging / Q000473:pathology*; D016277:Ventricular Function, Left / Q000502:physiology*
chemical_list: D001786:Blood Glucose; D008078:Cholesterol, LDL; D006442:Glycated Hemoglobin
keywords: ADA; American Diabetes Association; BMI; BP; CAD; CFR; CV; Coronary flow reserve; DM; DPP; DT; DTI; Diabetes; Diabetes Prevention Program; Doppler tissue-imaging; Echocardiography; FPG; Hs-CRP; IFG; IGT; IVRT; LAD; LV; LVMI; OGTT; Prediabetes; RAAS; TTDE; blood pressure; body-mass index; cardiovascular; coronary artery disease; coronary flow reserve; deceleration time; diabetes mellitus; fasting plasma glucose; high sensitivity C reactive protein; impaired fasting glucose; impaired glucose tolerance; isovolumic relaxation time; left anterior descending; left ventricular; left ventricular mass index; oral glucose tolerance test; renin angiotensin aldosterone system; transthoracic Doppler echocardiography