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Coronary atherosclerotic burden vs. coronary vascular function in diabetic and nondiabetic patients with normal myocardial perfusion: a propensity score analysis

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

To assess the relationship between coronary atherosclerotic burden and vascular function in diabetic and nondiabetic patients after balancing for coronary risk factors.

Methods

We studied 672 patients without overt coronary artery disease and normal myocardial perfusion on stress 82Rb PET/CT imaging. To account for differences in baseline characteristics between diabetic patients and nondiabetic patients, we created a propensity score-matched cohort considering clinical variables and coronary risk factors.

Results

Before matching, diabetic patients had higher coronary artery calcium (CAC) scores (p < 0.001) and lower coronary flow reserve (CFR; p < 0.001) than nondiabetic patients. After matching, CAC scores were comparable between diabetic and nondiabetic patients, but diabetic patients still had lower hyperaemic myocardial blood flow (p < 0.001) and CFR (p < 0.05). Patients were categorized by ln(CAC score) quartiles. There was a decrease in CFR with increasing CAC score quartile in both diabetic patients (p for trend < 0.01) and nondiabetic patients (p for trend < 0.005). Diabetes was associated with lower CFR across quartile categories (p < 0.002). In a multivariable linear regression analysis, CAC score was inversely related to CFR in both diabetic patients (p < 0.05) and nondiabetic patients (p < 0.001).

Conclusion

Diabetic patients had higher CAC scores than nondiabetic patients, but the difference disappeared when clinical characteristics were taken into account. Of note, diabetic patients also had lower CFR regardless of CAC score than nondiabetic patients after matching. Thus, coronary atherosclerotic burden and vascular function have to be seen as two different entities.

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Authors and Affiliations

  1. Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy

    Roberta Assante, Wanda Acampa, Emilia Zampella, Carmela Nappi & Alberto Cuocolo

  2. Institute of Biostructure and Bioimaging, National Council of Research, Naples, Italy

    Wanda Acampa, Valeria Gaudieri, Mariarosaria Panico & Mario Magliulo

  3. Nuclear Medicine Center, Central Manchester University Teaching Hospitals, Manchester, UK

    Parthiban Arumugam & Christine M. Tonge

  4. Department of Translational Medical Sciences, University Federico II, Naples, Italy

    Mario Petretta

Authors
  1. Roberta Assante
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  2. Wanda Acampa
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  3. Emilia Zampella
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  4. Parthiban Arumugam
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  5. Carmela Nappi
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  6. Valeria Gaudieri
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  7. Mariarosaria Panico
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  8. Mario Magliulo
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  10. Mario Petretta
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  11. Alberto Cuocolo
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Corresponding author

Correspondence to Alberto Cuocolo.

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Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the principles of the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Assante, R., Acampa, W., Zampella, E. et al. Coronary atherosclerotic burden vs. coronary vascular function in diabetic and nondiabetic patients with normal myocardial perfusion: a propensity score analysis. Eur J Nucl Med Mol Imaging 44, 1129–1135 (2017). https://doi.org/10.1007/s00259-017-3671-y

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  • DOI: https://doi.org/10.1007/s00259-017-3671-y

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