title: Associations of fractional pulse pressure to aortic stiffness and their impact on diastolic function and coronary flow reserve in asymptomatic diabetic patients with normal coronary angiography.
abstract: BACKGROUND
  We aimed to assess the relation of fractional pulse pressure (PPf) to aortic stiffness index and their impact on coronary flow reserve (CFR) and left ventricular diastolic function in asymptomatic diabetic patients.
  
  
  METHODS
  One hundred and thirty five consecutive asymptomatic diabetic patients (aged 48.8 ± 7.84 years), were included. CFR was calculated noninvasively using transthoracic echo-Doppler assessment with hyperemia induced by infusion of dipyridamole at a rate of 0.56 mg/kg over 4 min. PPf was calculated as pulse pressure divided by mean arterial pressure (SBP - DBP/MAP), while diastolic function was evaluated by means of transmitral flow and tissue Doppler imaging. Aortic stiffness indices (ASI) were measured as previously described.
  
  
  RESULTS
  Diabetic patients with low CFR (n = 52) compared with those with normal CFR (n = 83) exhibited significantly increased PPf (75.2 ± 11.4 vs. 64.5 ± 6.7, p < 0.001). PPf was significantly correlated with ASI (r = 0.520, p < 0.001), E/Em ratio (r = 0.425,p < 0.001) and left atrial volume index (r = 0.462, p < 0.001). CFR was negatively correlated with both PPf (r = -0.68, p < 0.0001). After applying multivariate linear regression analysis,after correction for cardiovascular risk factors, importantly, PPf and ASI remained significant predictors of CFR (p < 0.0001 and p < 0.001, respectively).
  
  
  CONCLUSIONS
  PPf was significantly correlated to ASI in asymptomatic diabetic patients. Likewise, increased PPf was associated with impaired CFR and subclinical diastolic dysfunction in diabetic patients. PPf could be utilized as a simple non-invasive predictor of occult atherosclerosis and diastolic dysfunction in diabetic patients.
authors: Cardiology Department, Faculty of Medicine, Zagazig University, Egypt. ragabmahfouz61@yahoo.com.
authors: Ragab A
authors: RA
authors: Mahfouz
authors: Waleed
authors: W
authors: Elawady
authors: Mohamed
authors: M
authors: Abdu
authors: Abdelhakem
authors: A
authors: Salem
mesh_terms: D000328:Adult; D058070:Asymptomatic Diseases; D001794:Blood Pressure; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000503:physiopathology; D003326:Coronary Circulation; D003925:Diabetic Angiopathies / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000503:physiopathology; D003971:Diastole; D015150:Echocardiography, Doppler; D005260:Female; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D011446:Prospective Studies; D059289:Vascular Stiffness; D016277:Ventricular Function, Left