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

• Published in: European journal of nuclear medicine and molecular imaging 2009-02, Vol.36 (2), p.219-229
• Main Authors: Schindler, Thomas H., Facta, Alvaro D., Prior, John O., Cadenas, Jerson, Zhang, Xiao-Li, Li, Yanjie, Sayre, James, Goldin, Jonathan, Schelbert, Heinrich R.
• Format: Article
• Language: English
• Subjects: Adenosine - pharmacology; Adult; Calcinosis; Cardiology; Carotid Arteries - pathology; Carotid Arteries - physiopathology; Circulatory system; Cold Temperature; Coronary Circulation; Coronary vessels; Coronary Vessels - metabolism; Coronary Vessels - pathology; Coronary Vessels - physiopathology; Diabetes; Diabetes Mellitus, Type 2 - diagnostic imaging; Diabetes Mellitus, Type 2 - physiopathology; Female; Humans; Imaging; Male; Medicine; Medicine & Public Health; Middle Aged; Nuclear Medicine; Oncology; Original Article; Orthopedics; Positron-Emission Tomography; Radiology; Rest; Sympathetic Nervous System - drug effects; Tomography; Vasodilation - drug effects
• ISSN: 1619-7070; 1619-7089
• DOI: 10.1007/s00259-008-0885-z

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 13 N-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.