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. 2018 Jan 11;17(1):11.
doi: 10.1186/s12933-017-0652-1.

Relationship between cardiac microvascular dysfunction measured with 82Rubidium-PET and albuminuria in patients with diabetes mellitus

Louis Potier  1   2   3 , Renata Chequer  4 , Ronan Roussel  5   6   7 , Kamel Mohammedi  5   6   7 , Souad Sismail  5 , Agnès Hartemann  8   9   10 , Chloé Amouyal  8   9   10 , Michel Marre  5   6   7 , Dominique Le Guludec  6   4   11 , Fabien Hyafil  6   4   11
Affiliations

Relationship between cardiac microvascular dysfunction measured with 82Rubidium-PET and albuminuria in patients with diabetes mellitus

Louis Potier et al. Cardiovasc Diabetol. .

Abstract

Background: Albuminuria is of one the strongest predictors of cardiovascular disease (CVD) in diabetes. Diabetes is associated with cardiac microvascular dysfunction (CMD), a powerful, independent prognostic factor for cardiac mortality. The aim of this study was to evaluate the relationship between CMD and microvascular complications in patients without known CVD.

Methods: In this monocentric study, myocardial flow reserve (MFR) was measured with cardiac 82Rubidium positron emission tomography (Rb-PET) in 311 patients referred to nuclear medicine department of Bichat University Hospital for screening of coronary artery disease from 2012 to 2014. Patients with hemodynamically relevant stenosis on coronary angiography or myocardial ischemia on Rb-PET were excluded. Among patients with diabetes, MFR values were compared according to the presence of retinopathy and albuminuria.

Results: Overall, 175 patients (118 with type 2 diabetes) were included. MFR was significantly lower in patients with diabetes compared with those without diabetes (2.6 ± 1.1 vs. 3.3 ± 1.7; p < 0.005). In patients with diabetes, MFR decreased progressively in relation to albumin urinary excretion (normoalbuminuria: 2.9 ± 1.1, microalbuminuria: 2.3 ± 1.0, macroalbuminuria: 1.8 ± 0.7; p < 0.0001). MFR was not significantly different in patients with vs. without retinopathy (2.4 ± 1.0 vs. 2.7 ± 1.1, p = 0.07). Microalbuminuria and macroalbuminuria remained strongly associated with impaired MFR after multiple adjustments [odds ratio 2.6 (95% CI 1.1-8.4) and 5.3 (95% CI 1.2-44.7), respectively]. This association was confirmed when analyses were restricted to patients with low levels of coronary calcifications on computed tomography.

Conclusions: Impaired MFR was more frequent in patients with diabetes and was strongly associated with the degree of albuminuria suggesting that CMD and albuminuria might share common mechanisms.

Keywords: Albuminuria; Coronary microvascular dysfunction; Diabetes; Diabetic nephropathy.

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Figures

Fig. 1
Fig. 1
CONSORT flow chart showing the selection of patients included in this study
Fig. 2
Fig. 2
Representative examples of Rubidium-PET myocardial perfusion imaging (MPI) of diabetic patients with normoalbuminuria (A) and macroalbuminuria (B). No myocardial ischemia was present on Rb-PET MPI (a), nor coronary calcification on the low-dose CT used for attenuation correction of PET images (b) in both patients. Quantification of myocardial blood flow (MBF) with Rb-PET evidenced the presence of a global normal stress MBF and myocardial flow reserve in favor of a normal cardiac microvascular function (MFR = 5.1) in normoalbuminuric patient and a global low stress MBF and myocardial flow reserve in favor of cardiac microvascular dysfunction (MFR = 1.6) in macroalbuminuric patient (c)
Fig. 3
Fig. 3
Adjusted MFR according degree of albuminuria (estimated marginal means with standard of error means). Adjusted for age, sex, BMI, eGFR, duration of diabetes, HbA1c, and systolic BP. *p < 0.05
See this image and copyright information in PMC

References

    1. Gregg EW, Williams DE, Geiss L. Changes in diabetes-related complications in the United States. N Engl J Med. 2014;371(3):286–287. - PubMed
    1. de Zeeuw D, Parving HH, Henning RH. Microalbuminuria as an early marker for cardiovascular disease. J Am Soc Nephrol. 2006;17(8):2100–2105. doi: 10.1681/ASN.2006050517. - DOI - PubMed
    1. Go AS, Chertow GM, Fan D, McCulloch CE, Hsu CY. Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med. 2004;351(13):1296–1305. doi: 10.1056/NEJMoa041031. - DOI - PubMed
    1. Matsushita K, Coresh J, Sang Y, Chalmers J, Fox C, Guallar E, et al. Estimated glomerular filtration rate and albuminuria for prediction of cardiovascular outcomes: a collaborative meta-analysis of individual participant data. Lancet Diabetes Endocrinol. 2015;3(7):514–525. doi: 10.1016/S2213-8587(15)00040-6. - DOI - PMC - PubMed
    1. Jackson CE, Solomon SD, Gerstein HC, Zetterstrand S, Olofsson B, Michelson EL, et al. Albuminuria in chronic heart failure: prevalence and prognostic importance. Lancet. 2009;374(9689):543–550. doi: 10.1016/S0140-6736(09)61378-7. - DOI - PubMed

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