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First published online November 12, 2009, 10.2967/jnumed.109.065193
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Journal of Nuclear Medicine Vol. 50 No. 12 1980-1986
© 2009 by Society of Nuclear Medicine
doi: 10.2967/jnumed.109.065193

Clinical Investigation

Endothelial Dysfunction in Diabetic Patients with Abnormal Myocardial Perfusion in the Absence of Epicardial Obstructive Coronary Artery Disease

Roxana Djaberi1, Jos op 't Roodt2, Joanne D. Schuijf1, Ton J. Rabelink2, Eelco J. de Koning2, Alberto M. Pereira3, Marcel P. Stokkel4, Jan W. Smit3, Jeroen J. Bax1 and J. Wouter Jukema1,5

1 Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands; 2 Department of Nephrology, Leiden University Medical Center, Leiden, The Netherlands; 3 Department of Endocrinology, Leiden University Medical Center, Leiden, The Netherlands; 4 Department of Nuclear Medicine, Leiden University Medical Center, Leiden, The Netherlands; and 5 Einthoven Laboratory of Experimental Vascular Medicine, Leiden, The Netherlands

Correspondence: For correspondence or reprints contact: Jeroen J. Bax, Department of Cardiology, Leiden University Medical Center, Postbus 9600, 2300 RC, Leiden, The Netherlands. E-mail: J.J.Bax{at}lumc.nl

In patients with diabetes mellitus, myocardial perfusion defects are often observed in the absence of obstructive epicardial coronary artery disease (CAD), thereby presenting a diagnostic problem. We hypothesized that these perfusion abnormalities may be explained by endothelial dysfunction or occult coronary atherosclerosis. Methods: Prospectively, 130 asymptomatic patients with diabetes mellitus underwent cardiovascular screening by coronary artery calcium (CAC) scoring, multislice CT coronary angiography, and myocardial perfusion imaging by SPECT. Multislice CT images were evaluated for the presence of obstructive epicardial CAD (≥50% luminal narrowing). To quantify abnormal myocardial perfusion on SPECT images, we determined the summed stress score for each patient. The presence of abnormal myocardial perfusion was defined as a summed stress score of 3 or more. In addition, flow-mediated dilatation of the brachial artery, a marker of endothelial function, was determined using ultrasonography. Results: In 35 patients (27%), obstructive epicardial CAD was observed on multislice CT, and these patients were excluded from further analysis. In the remaining 95 patients, abnormal myocardial perfusion was observed in 30 (32%) of patients. Flow-mediated dilatation was significantly lower in patients with abnormal myocardial perfusion (3.6% ± 2.4%) than in those with normal myocardial perfusion (6.4% ± 2.6%) (P < 0.001). Importantly, flow-mediated dilatation remained a significant predictor of the extent of abnormal myocardial perfusion after correction for cardiovascular risk factors and CAC score (P < 0.001). In contrast, no association was observed between nonobstructive plaque burden as reflected by CAC scores and extent of abnormal myocardial perfusion. Conclusion: In patients with diabetes mellitus, myocardial perfusion abnormalities in the absence of obstructive epicardial CAD are associated with endothelial dysfunction.

Key Words: diabetes mellitus • endothelium • myocardial perfusion • coronary artery disease

COPYRIGHT © 2009 by the Society of Nuclear Medicine, Inc.


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