Abstract 12969: Association between Abnormal Glucose Metabolism and Coronary Hyper-perfusion in Normal Coronary Patients Without Ischemic Heart Disease
Background: Abnormal glucose metabolism (AGM) could cause microvascular dysfunction in heart. We hypothesized that AGM might be associated with impaired myocardial circulation.
Methods: Consecutive 368 stable patients suspected angina with normal coronary arteries were initially enrolled. We performed intracoronary acetylcholine-provocation test, and measured adenosine triphosphate-induced coronary flow reserve (CFR) to diagnose the presence of non-obstructive ischemic heart disease (IHD) by using Doppler FloWire at the proximal site of left anterior descending coronary artery before taking any vasodilators at the basal non-stress condition. Myocardial lactate consumption was measured by sampling at aortic root and coronary sinus. AGM was defined as medical history of diabetes or impaired glucose tolerance by 75g oral glucose tolerance test.
Results: We identified epicardial vasospasm (n=206) and microvascular angina (n=71) as IHD. 62 patients (33 women, age 63.2±10.8) were identified as non-IHD. Among the non-IHD patients, the basal average peak velocity (bAPV) and the basal coronary blood flow volume (bCBFV) were significantly greater in AGM patients (n=21) than in patients with normal glucose tolerance (control; n=41) (bAPV: 22.6±6.4 vs. 18.4±5.1 cm/sec, p=0.01, bCBFV: 51.9±17.0 vs. 41.1±13.8 ml/min, p=0.01) indicating the presence of hyper-perfusion in heart. In the coronary flow wave analysis, the diastolic to systolic velocity ratio was lower in the AMG group compared to control (1.78±0.43 vs. 2.01±0.47, p=0.095) indicating the elevated systolic flow. The amount of myocardial lactate extraction tended to be lower in the AGM group compared to control but no statistically significance (1.57±1.31 vs. 1.80±1.61 mg/dL, p=0.58). Multivariate logistic regression analysis among various clinical factors revealed that AGM was independently associated with the presence of higher bCBFV (≥45.0 ml/min) (odds ratio: 4.33, 95% confidence interval: 1.32-14.2, p=0.02).
Conclusion: Non-IHD patients with AGM demonstrated significantly higher levels of bCBFV and the systolic coronary flow in AMG tended to be elevated compared to control. AMG was associated with hyper-perfusion in heart as the impairment of coronary microcirculation.
- © 2013 by American Heart Association, Inc.