Structural alterations of the coronary arterial wall are associated with myocardial flow heterogeneity in type 2 diabetes mellitus

Thomas H. Schindler, Alvaro D. Facta, John O. Prior, Jerson Cadenas, Xiao Li Zhang, Yanjie Li, James Sayre, Jonathan Goldin, Heinrich R. Schelbert

Research output: Contribution to journalArticle

36 Scopus citations

Abstract

Purpose: To determine the relationship between carotid intima-media thickness (IMT), coronary artery calcification (CAC), and myocardial blood flow (MBF) at rest and during vasomotor stress in type 2 diabetes mellitus (DM). Methods: In 68 individuals, carotid IMT was measured using high-resolution vascular ultrasound, while the presence of CAC was determined with electron beam tomography (EBT). Global and regional MBF was determined in milliliters per gram per minute with 13N-ammonia and positron emission tomography (PET) at rest, during cold pressor testing (CPT), and during adenosine (ADO) stimulation. Results: There was neither a relationship between carotid IMT and CAC (r=0.10, p=0.32) nor between carotid IMT and coronary circulatory function in response to CPT and during ADO (r=-0.18, p=0.25 and r=0.10, p=0.54, respectively). In 33 individuals, EBT detected CAC with a mean Agatston-derived calcium score of 44±18. There was a significant difference in regional MBFs between territories with and without CAC at rest and during ADO-stimulated hyperemia (0.69±0.24 vs. 0.74±0.23 and 1.82±0.50 vs. 1.95±0.51 ml/g/min; p≤0.05, respectively) and also during CPT in DM but less pronounced (0.81±0.24 vs. 0.83±0.23 ml/g/min; p=ns). The increase in CAC was paralleled with a progressive regional decrease in resting as well as in CPT- and ADO-related MBFs (r=-0.36, p≤0.014; r=-0.46, p≤0.007; and r=-0.33, p≤0.041, respectively). Conclusions: The absence of any correlation between carotid IMT and coronary circulatory function in type 2 DM suggests different features and stages of early atherosclerosis in the peripheral and coronary circulation. PET-measured MBF heterogeneity at rest and during vasomotor stress may reflect downstream fluid dynamic effects of coronary artery disease (CAD)-related early structural alterations of the arterial wall.

Original languageEnglish
Pages (from-to)219-229
Number of pages11
JournalEuropean Journal of Nuclear Medicine and Molecular Imaging
Volume36
Issue number2
DOIs
StatePublished - Feb 1 2009
Externally publishedYes

Keywords

  • Blood flow
  • Carotid IMT
  • Circulation
  • Cold pressor test
  • Coronary artery calcification
  • Diabetes mellitus
  • Flow heterogeneity
  • Tomography
  • Vasomotor function

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