title: Flow-mediated-paradoxical vasoconstriction is independently associated with asymptomatic myocardial ischemia and coronary artery disease in type 2 diabetic patients.
abstract: BACKGROUND
  To investigate whether flow-mediated dilation (FMD) impairment, which precedes overt atherosclerosis, is associated with silent myocardial ischemia (SMI) and asymptomatic coronary artery disease (CAD) in type 2 diabetes.
  
  
  METHODS
  Forearm FMD was measured by ultrasonography in 25 healthy control, 30 non-diabetic overweight or obese patients and 118 asymptomatic type 2 diabetic patients with a high cardiovascular risk profile. SMI (abnormal stress myocardial scintiscan and/or stress dobutamine echocardiogram) and CAD (coronary angiography in the patients with SMI) were assessed in the diabetic cohort.
  
  
  RESULTS
  FMD was lower in diabetic patients (median 0.61% (upper limits of first and third quartiles -1.22;3.2)) than in healthy controls (3.95% (1.43;5.25), p < 0.01) and overweight/obese patients (4.25% (1.74;5.56), p < 0.01). SMI was present in 60 diabetic patients, including 21 subjects with CAD. FMD was lower in patients with SMI than in those without (0.12% (-2.3;1.58) vs 1.64% (0;3.69), p < 0.01), with a higher prevalence of paradoxical vasoconstriction (50.0% vs 29.3%, p < 0.05). FMD was also lower in patients with than without CAD (-1.22% (-2.5;1) vs 1.13% (-0.4;3.28), p < 0.01; paradoxical vasoconstriction 61.9% vs 34.4%, p < 0.05). Logistic regression analyses considering the parameters predicting SMI or CAD in univariate analyses with a p value <0.10 showed that paradoxical vasoconstriction (odds ratio 2.7 [95% confidence interval 1.2-5.9], p < 0.05) and nephropathy (OR 2.6 [1.2-5.7], p < 0.05) were independently associated with SMI; and only paradoxical vasoconstriction (OR 3.1 [1.2-8.2], p < 0.05) with CAD. The negative predictive value of paradoxical vasoconstriction to detect CAD was 88.7%.
  
  
  CONCLUSIONS
  In diabetic patients, FMD was independently associated with SMI and asymptomatic CAD.
  
  
  BACKGROUND
  Trial registration number NCT00685984.
authors.forename: Minh Tuan
authors.initials: MT
authors.lastname: Nguyen
authors.forename: Isabelle
authors.initials: I
authors.lastname: Pham
authors.forename: Paul
authors.initials: P
authors.lastname: Valensi
authors.forename: Hélène
authors.initials: H
authors.lastname: Rousseau
authors.forename: Eric
authors.initials: E
authors.lastname: Vicaut
authors.forename: Christelle
authors.initials: C
authors.lastname: Laguillier-Morizot
authors.forename: Alain
authors.initials: A
authors.lastname: Nitenberg
authors.affiliation: AP-HP, Jean Verdier Hospital, Department of Endocrinology-Diabetology-Nutrition and Paris 13 University, CRNH-IdF, CINFO, Avenue du 14 juillet, Hôpital Jean Verdier, 93143, Bondy Cedex, France. emmanuel.cosson@jvr.aphp.fr.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Cosson
mesh_terms: D000328:Adult; D000368:Aged; D058070:Asymptomatic Diseases; D001783:Blood Flow Velocity / Q000502:physiology*; D015331:Cohort Studies; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000503:physiopathology; D003924:Diabetes Mellitus, Type 2 / Q000000981:diagnostic imaging* / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging* / Q000503:physiopathology; D012307:Risk Factors; D014463:Ultrasonography; D014661:Vasoconstriction / Q000502:physiology*; D055815:Young Adult