title: Prognostic value of coronary flow reserve assessed by transthoracic Doppler echocardiography on long-term outcome in asymptomatic patients with type 2 diabetes without overt coronary artery disease.
abstract: BACKGROUND
  Cardiovascular risk stratification of asymptomatic diabetic patients is important and remains a difficult clinical problem. Our aim was to test the hypothesis that coronary flow reserve (CFR) assessed by noninvasive transthoracic Doppler echocardiography predicts prognosis in those patients.
  
  
  METHODS
  From February 2002 to January 2005, we evaluated 135 consecutive asymptomatic patients (74 male; mean age, 63 ± 9 years) with type 2 diabetes without a history of coronary artery disease. Adenosine triphosphate (0.14 mg/kg/min) stress Doppler echocardiography was performed to evaluate CFR of the left anterior descending artery. Patients with a CFR < 2.0 were also excluded based on the suspicion of significant coronary artery stenosis in the left anterior descending artery.
  
  
  RESULTS
  There were 111 patients (60 male; mean age, 64 ± 9 years) enrolled. During a median follow-up of 79 months, 20 events (5 deaths, 7 acute coronary syndromes, 8 coronary revascularizations) occurred. The optimal cut-off value of CFR to predict events was 2.5 (area under the receiver-operating characteristic curve = 0.65). Multivariate analysis showed that the independent prognostic indicators were male gender (p < 0.05) and a CFR < 2.5 (p < 0.01). Kaplan-Mayer analysis revealed that the event rate was significantly higher (log-lank, p < 0.01) in patients with CFR < 2.5 than in those with CFR ≥ 2.5.
  
  
  CONCLUSIONS
  CFR obtained by transthoracic Doppler echocardiography provides independent prognostic information in asymptomatic patients with type 2 diabetes without overt coronary artery disease. Patients with CFR < 2.5 had a worse long-term outcome.
authors: Department of Cardiology, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan. DQH07724@nifty.ne.jp.
authors: Takayuki
authors: T
authors: Kawata
authors: Masao
authors: M
authors: Daimon
authors: Rei
authors: R
authors: Hasegawa
authors: Tomohiko
authors: T
authors: Toyoda
authors: Tai
authors: T
authors: Sekine
authors: Toshiharu
authors: T
authors: Himi
authors: Daigaku
authors: D
authors: Uchida
authors: Sakiko
authors: S
authors: Miyazaki
authors: Kuniaki
authors: K
authors: Hirose
authors: Ryoko
authors: R
authors: Ichikawa
authors: Masaki
authors: M
authors: Maruyama
authors: Hiromasa
authors: H
authors: Suzuki
authors: Hiroyuki
authors: H
authors: Daida
mesh_terms: D054058:Acute Coronary Syndrome / Q000209:etiology; D000368:Aged; D058070:Asymptomatic Diseases; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D003326:Coronary Circulation; D003331:Coronary Vessels / Q000000981:diagnostic imaging* / Q000503:physiopathology; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D003925:Diabetic Angiopathies / Q000000981:diagnostic imaging* / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D018450:Disease Progression; D015150:Echocardiography, Doppler; D025401:Echocardiography, Stress; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D013997:Time Factors
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