Prognostic value of coronary flow reserve assessed by transthoracic Doppler echocardiography on long-term outcome in asymptomatic patients with type 2 diabetes without overt coronary artery disease

Cardiovasc Diabetol. 2013 Aug 27:12:121. doi: 10.1186/1475-2840-12-121.

Abstract

Background: Cardiovascular risk stratification of asymptomatic diabetic patients is important and remains a difficult clinical problem. Our aim was to test the hypothesis that coronary flow reserve (CFR) assessed by noninvasive transthoracic Doppler echocardiography predicts prognosis in those patients.

Methods: From February 2002 to January 2005, we evaluated 135 consecutive asymptomatic patients (74 male; mean age, 63 ± 9 years) with type 2 diabetes without a history of coronary artery disease. Adenosine triphosphate (0.14 mg/kg/min) stress Doppler echocardiography was performed to evaluate CFR of the left anterior descending artery. Patients with a CFR < 2.0 were also excluded based on the suspicion of significant coronary artery stenosis in the left anterior descending artery.

Results: There were 111 patients (60 male; mean age, 64 ± 9 years) enrolled. During a median follow-up of 79 months, 20 events (5 deaths, 7 acute coronary syndromes, 8 coronary revascularizations) occurred. The optimal cut-off value of CFR to predict events was 2.5 (area under the receiver-operating characteristic curve = 0.65). Multivariate analysis showed that the independent prognostic indicators were male gender (p < 0.05) and a CFR < 2.5 (p < 0.01). Kaplan-Mayer analysis revealed that the event rate was significantly higher (log-lank, p < 0.01) in patients with CFR < 2.5 than in those with CFR ≥ 2.5.

Conclusions: CFR obtained by transthoracic Doppler echocardiography provides independent prognostic information in asymptomatic patients with type 2 diabetes without overt coronary artery disease. Patients with CFR < 2.5 had a worse long-term outcome.

Publication types

  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Coronary Syndrome / etiology
  • Aged
  • Asymptomatic Diseases
  • Coronary Artery Disease / diagnostic imaging*
  • Coronary Artery Disease / etiology
  • Coronary Artery Disease / mortality
  • Coronary Artery Disease / physiopathology
  • Coronary Artery Disease / therapy
  • Coronary Circulation*
  • Coronary Vessels / diagnostic imaging*
  • Coronary Vessels / physiopathology
  • Diabetes Mellitus, Type 2 / complications*
  • Diabetic Angiopathies / diagnostic imaging*
  • Diabetic Angiopathies / etiology
  • Diabetic Angiopathies / mortality
  • Diabetic Angiopathies / physiopathology
  • Diabetic Angiopathies / therapy
  • Disease Progression
  • Echocardiography, Doppler*
  • Echocardiography, Stress*
  • Female
  • Humans
  • Kaplan-Meier Estimate
  • Male
  • Middle Aged
  • Myocardial Revascularization
  • Predictive Value of Tests
  • Prognosis
  • Prospective Studies
  • Risk Factors
  • Time Factors