title: Diabetes mellitus and coronary microvascular function in asymptomatic patients with severe aortic stenosis and nonobstructed coronary arteries.
abstract: Coronary flow reserve is impaired in asymptomatic patients with aortic stenosis and has a prognostic value. We investigated whether the type II diabetes mellitus additionally impairs microvascular circulation assessed by coronary flow reserve in patients with asymptomatic severe aortic stenosis, normal left ventricular ejection fraction and nonobstructed coronary arteries.
  
  
  
  A total of 128 patients, mean age of 66.35 ± 10.51 (58.6% males), with severe aortic stenosis and normal left ventricular ejection fraction were enrolled in this study. Patients with diabetes mellitus, those who were treated for diabetes mellitus or had documentation confirming the diagnosis of diabetes mellitus, were considered. All patients underwent coronary angiography and had no obstructive coronary disease (defined as having no stenosis >50% in diameter), standard transthoracic Doppler-echocardiographic study and adenosine stress transthoracic echocardiography for coronary flow reserve measurement.
  
  
  
  Diabetes mellitus was present in 26 patients (20.31%). There was no significant difference in aortic stenosis severity between diabetic and non-diabetic patients [aortic valve area (0.81 ± 0.18 vs 0.85 ± 0.15 cm(2)) and Vmax (4.20 ± 0.57 vs 4.21 ± 0.48 m/s)]. Mean coronary flow reserve in diabetic patients was 1.98 ± 0.48, while mean coronary flow reserve in non-diabetic patients was 2.64 ± 0.54 (p < 0.01). Diabetes mellitus was independent predictor of coronary flow reserve [B = -0.636, 95% confidence interval (-0.916 to -0.368), p < 0.001].
  
  
  
  Diabetes mellitus additionally impairs coronary microvascular function in asymptomatic patients with severe aortic stenosis and nonobstructed coronary arteries.
authors.affiliation: Departments of Non-Invasive Cardiology and Cardiology Clinic, Clinical Centre of Serbia, Belgrade, Serbia Belgrade Medical School, University of Belgrade, Belgrade, Serbia markobanovic71@gmail.com.
authors.forename: Marko
authors.initials: M
authors.lastname: Banovic
authors.affiliation: Departments of Non-Invasive Cardiology and Cardiology Clinic, Clinical Centre of Serbia, Belgrade, Serbia.
authors.forename: Voin
authors.initials: V
authors.lastname: Brkovic
authors.affiliation: Departments of Non-Invasive Cardiology and Cardiology Clinic, Clinical Centre of Serbia, Belgrade, Serbia Belgrade Medical School, University of Belgrade, Belgrade, Serbia.
authors.forename: Ivana
authors.initials: I
authors.lastname: Nedeljkovic
authors.affiliation: Departments of Non-Invasive Cardiology and Cardiology Clinic, Clinical Centre of Serbia, Belgrade, Serbia Belgrade Medical School, University of Belgrade, Belgrade, Serbia.
authors.forename: Milan
authors.initials: M
authors.lastname: Nedeljkovic
authors.affiliation: Departments of Non-Invasive Cardiology and Cardiology Clinic, Clinical Centre of Serbia, Belgrade, Serbia.
authors.forename: Dejana
authors.initials: D
authors.lastname: Popovic
authors.affiliation: Departments of Non-Invasive Cardiology and Cardiology Clinic, Clinical Centre of Serbia, Belgrade, Serbia Belgrade Medical School, University of Belgrade, Belgrade, Serbia.
authors.forename: Ana
authors.initials: A
authors.lastname: Djordjevic-Dikic
authors.affiliation: Departments of Non-Invasive Cardiology and Cardiology Clinic, Clinical Centre of Serbia, Belgrade, Serbia Belgrade Medical School, University of Belgrade, Belgrade, Serbia.
authors.forename: Arsen
authors.initials: A
authors.lastname: Ristic
authors.affiliation: BioVentrix, San Ramon, CA, USA.
authors.forename: Srdjan
authors.initials: S
authors.lastname: Nikolic
authors.affiliation: Departments of Non-Invasive Cardiology and Cardiology Clinic, Clinical Centre of Serbia, Belgrade, Serbia Belgrade Medical School, University of Belgrade, Belgrade, Serbia.
authors.forename: Branko
authors.initials: B
authors.lastname: Beleslin
mesh_terms: D000241:Adenosine / Q000008:administration & dosage; D000368:Aged; D001024:Aortic Valve Stenosis / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology; D058070:Asymptomatic Diseases; D016022:Case-Control Studies; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology; D003326:Coronary Circulation; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000503:physiopathology*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications* / Q000175:diagnosis; D003925:Diabetic Angiopathies / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology; D015150:Echocardiography, Doppler; D025401:Echocardiography, Stress / Q000379:methods; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008833:Microcirculation; D055806:Microvessels / Q000000981:diagnostic imaging / Q000503:physiopathology*; D008875:Middle Aged; D011379:Prognosis; D012307:Risk Factors; D012720:Severity of Illness Index; D013318:Stroke Volume; D013997:Time Factors; D014665:Vasodilator Agents / Q000008:administration & dosage; D016277:Ventricular Function, Left
chemical_list: D014665:Vasodilator Agents; D000241:Adenosine
keywords: Aortic stenosis; asymptomatic; diabetes mellitus; microcirculation