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Observational Study
. 2013 Aug 27:12:121.
doi: 10.1186/1475-2840-12-121.

Prognostic value of coronary flow reserve assessed by transthoracic Doppler echocardiography on long-term outcome in asymptomatic patients with type 2 diabetes without overt coronary artery disease

Takayuki Kawata  1 , Masao Daimon, Rei Hasegawa, Tomohiko Toyoda, Tai Sekine, Toshiharu Himi, Daigaku Uchida, Sakiko Miyazaki, Kuniaki Hirose, Ryoko Ichikawa, Masaki Maruyama, Hiromasa Suzuki, Hiroyuki Daida
Affiliations
Observational Study

Prognostic value of coronary flow reserve assessed by transthoracic Doppler echocardiography on long-term outcome in asymptomatic patients with type 2 diabetes without overt coronary artery disease

Takayuki Kawata et al. Cardiovasc Diabetol. .

Abstract

Background: Cardiovascular risk stratification of asymptomatic diabetic patients is important and remains a difficult clinical problem. Our aim was to test the hypothesis that coronary flow reserve (CFR) assessed by noninvasive transthoracic Doppler echocardiography predicts prognosis in those patients.

Methods: From February 2002 to January 2005, we evaluated 135 consecutive asymptomatic patients (74 male; mean age, 63 ± 9 years) with type 2 diabetes without a history of coronary artery disease. Adenosine triphosphate (0.14 mg/kg/min) stress Doppler echocardiography was performed to evaluate CFR of the left anterior descending artery. Patients with a CFR < 2.0 were also excluded based on the suspicion of significant coronary artery stenosis in the left anterior descending artery.

Results: There were 111 patients (60 male; mean age, 64 ± 9 years) enrolled. During a median follow-up of 79 months, 20 events (5 deaths, 7 acute coronary syndromes, 8 coronary revascularizations) occurred. The optimal cut-off value of CFR to predict events was 2.5 (area under the receiver-operating characteristic curve = 0.65). Multivariate analysis showed that the independent prognostic indicators were male gender (p < 0.05) and a CFR < 2.5 (p < 0.01). Kaplan-Mayer analysis revealed that the event rate was significantly higher (log-lank, p < 0.01) in patients with CFR < 2.5 than in those with CFR ≥ 2.5.

Conclusions: CFR obtained by transthoracic Doppler echocardiography provides independent prognostic information in asymptomatic patients with type 2 diabetes without overt coronary artery disease. Patients with CFR < 2.5 had a worse long-term outcome.

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Figures

Figure 1
Figure 1
Kaplan-Meier curves for all events (all cause death, ACS and revascularization) in patients stratified according to their CFR (≥ 2.5 or < 2.5).
Figure 2
Figure 2
Kaplan-Meier curves for cardiac hard events (cardiac death and ACS) in patients stratified according to their CFR (≥ 2.5 or < 2.5).
See this image and copyright information in PMC

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