Abstract 17129: Prevalence and Correlation of Abnormal Flow Reserve by Stress Cmr and Coronary Artery Plaque by Cardiac CTA in Symptomatic Patients With Diabetes
Introduction: Patients with diabetes mellitus (DM) and angina have high morbidity and mortality after negative stress cardiac imaging, and myocardial perfusion reserve (MPR) measures provide additional prognostic information. We aimed to determine the association of abnormal MPR with the extent of coronary artery disease (CAD) in symptomatic diabetics.
Method: Symptomatic diabetics age 18-85 without known CAD referred for stress imaging were included. Quantitative stress CMR and coronary CT angiography (CTA) were performed. Plaque distribution was characterized by “segment score” (max score of 16). Plaque severity was graded as 0=none; 1≤30%; 2=30-50%; 3=50-75%; 4≥75%. Plaque scores were summed across all segments into a “total plaque score” (max= 64). Quantitative CMR perfusion analysis was performed using Fermi deconvolution. Patients were stratified by MPR <2 and ≥2. Data were compared using Kruskal-Wallis and Fisher’s Exact testing.
Result: Complete data were available in 39 patients. Median age was 59 (51-67] years; 38% were males and 61% had BMI ≥30. There were no differences in baseline characteristics by MPR group. The prevalence of MPR <2 was 28%. Obstructive CAD was identified in 15% (≥50% stenosis) and 8% (≥70% stenosis). The absence of coronary plaque was noted in 26%. Among patients with any plaque, those with an MPR<2 had a significantly higher segment score (p=0.04) and a strong trend towards a higher plaque score (p=0.06) than those with MPR ≥2.
Conclusion: A substantial prevalence of abnormal MPR was identified in symptomatic patients with DM. One quarter of those with no plaque had abnormal MPR, indicating microvascular dysfunction. In addition, a significant association between abnormal MPR <2 and increased plaque extent was identified. These data suggest that MPR and CAD extent on CT provide related but unique information in the evaluation of symptomatic diabetic patients.
Author Disclosures: Y.S. Hamirani: None. M. Salerno: None. Y. Yang: None. C.M. Kramer: None. J. Bourque: None.
- © 2014 by American Heart Association, Inc.