title: Coronary microvascular function, insulin sensitivity and body composition in predicting exercise capacity in overweight patients with coronary artery disease.
abstract: BACKGROUND
  Coronary artery disease (CAD) has a negative impact on exercise capacity. The aim of this study was to determine how coronary microvascular function, glucose metabolism and body composition contribute to exercise capacity in overweight patients with CAD and without diabetes.
  
  
  METHODS
  Sixty-five non-diabetic, overweight patients with stable CAD, BMI 28-40 kg/m(2) and left ventricular ejection fraction (LVEF) above 35 % were recruited. A 3-hour oral glucose tolerance test was used to evaluate glucose metabolism. Peak aerobic exercise capacity (VO2peak) was assessed by a cardiopulmonary exercise test. Body composition was determined by whole body dual-energy X-ray absorptiometry scan and magnetic resonance imaging. Coronary flow reserve (CFR) assessed by transthoracic Doppler echocardiography was used as a measure of microvascular function.
  
  
  RESULTS
  Median BMI was 31.3 and 72 % had impaired glucose tolerance or impaired fasting glucose. VO2peak adjusted for fat free mass was correlated with CFR (r = 0.41, p = 0.0007), LVEF (r = 0.33, p = 0.008) and left ventricular end-diastolic volume (EDV) (r = 0.32, p = 0.01) while it was only weakly linked to measures of glucose metabolism and body composition. CFR, EDV and LVEF remained independent predictors of VO2peak in multivariable regression analysis.
  
  
  CONCLUSIONS
  The study established CFR, EDV and LVEF as independent predictors of VO2peak in overweight CAD patients with no or only mild functional symptoms and a LVEF > 35 %. Glucose metabolism and body composition had minor impact on VO2peak. The findings suggest that central hemodynamic factors are important in limiting exercise capacity in overweight non-diabetic CAD patients.
authors.affiliation: Department of Cardiology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark. andersjurs@gmail.com.
authors.forename: Anders
authors.initials: A
authors.lastname: Jürs
authors.affiliation: Department of Cardiology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark. lrpedersen@gmail.com.
authors.forename: Lene Rørholm
authors.initials: LR
authors.lastname: Pedersen
authors.affiliation: Department of Cardiology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark. rasmus.huan.olsen@gmail.com.
authors.forename: Rasmus Huan
authors.initials: RH
authors.lastname: Olsen
authors.affiliation: Department of Cardiology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark. snoer@dadlnet.dk.
authors.forename: Martin
authors.initials: M
authors.lastname: Snoer
authors.affiliation: Department of Radiology, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark. Elizaveta.Chabanova@regionh.dk.
authors.forename: Elizaveta
authors.initials: E
authors.lastname: Chabanova
authors.affiliation: Department of Internal Medicine, Amager Hospital and the Clinical Research Center, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark. d299057@dadlnet.dk.
authors.forename: Steen Bendix
authors.initials: SB
authors.lastname: Haugaard
authors.affiliation: Department of Cardiology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark. Eva.Irene.Bossano.Prescott@regionh.dk.
authors.forename: Eva
authors.initials: E
authors.lastname: Prescott
mesh_terms: D015502:Absorptiometry, Photon; D000368:Aged; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000378:metabolism; D001823:Body Composition; D015992:Body Mass Index; D003324:Coronary Artery Disease / Q000097:blood / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology* / Q000628:therapy; D003326:Coronary Circulation; D003331:Coronary Vessels / Q000503:physiopathology*; D003718:Denmark; D015150:Echocardiography, Doppler; D005080:Exercise Test; D017079:Exercise Tolerance; D005260:Female; D005951:Glucose Tolerance Test; D006801:Humans; D007328:Insulin / Q000097:blood; D007333:Insulin Resistance; D008279:Magnetic Resonance Imaging; D008297:Male; D008833:Microcirculation; D055806:Microvessels / Q000503:physiopathology*; D008875:Middle Aged; D050177:Overweight / Q000097:blood / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology* / Q000628:therapy; D010101:Oxygen Consumption; D011237:Predictive Value of Tests; D012307:Risk Factors; D013318:Stroke Volume; D013997:Time Factors; D016277:Ventricular Function, Left
chemical_list: D015415:Biomarkers; D001786:Blood Glucose; D007328:Insulin