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Coronary Microangiopathy in Type 2 Diabetic Patients: Relation to Glycemic Control, Sex, and Microvascular Angina Rather Than to Coronary Artery Disease

Departments of Cardiovascular Medicine, Radiology, and Metabolic Diseases, University of Tokyo, Tokyo, Japan

Correspondence: For correspondence or reprints contact: Ikuo Yokoyama, MD, Department of Cardiovascular Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan 113-8655.

ABSTRACT

Coronary microangiopathy is a major complication in diabetics. However, the presence of independent factors in association with coronary microangiopathy in patients with non-insulin-dependent diabetes mellitus (NIDDM) or the difference in coronary microangiopathy between diabetics with coronary artery disease (CAD) and those with microvascular angina is unclear. Methods: Nineteen patients with NIDDM and microvascular angina, 18 patients with NIDDM and CAD, and 17 age-matched control subjects were studied. Myocardial segments that were perfused by angiographically normal coronary arteries were studied. The baseline myocardial blood flow (MBF) and the MBF during dipyridamole administration were measured using PET and ¹³N-ammonia, after which the myocardial flow reserve (MFR) was calculated to assess coronary microangiopathy. Results: The baseline MBF was comparable among NIDDM patients with microvascular angina, NIDDM patients with CAD, and control subjects. However, the MBF during dipyridamole administration was significantly lower in NIDDM patients with microvascular angina (126 ± 42.7 mL/min/100 g) than that in either NIDDM patients with CAD (210 ± 70.1 mL/min/100 g; P < 0.01) or control subjects (293 ± 159 mL/min/100 g; P < 0.01), as was the MFR (NIDDM with microvascular angina, 1.90 ± 0.73; NIDDM with CAD, 2.59 ± 0.81 [P < 0.01]; control subjects, 3.69 ± 1.09 [P < 0.01]). Multivariate stepwise regression analysis showed that, among the factors considered, glycemic control was independently related to the MFR (r = 0.838; P < 0.05). Conclusion: Glycemic control appears to be essential for coronary microangiopathy in NIDDM.

Key Words: hyperglycemia • non-insulin-dependent diabetes mellitus • flow reserve • atherosclerosis • coronary microangiopathy

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