Key result
Macroalbuminuria in T1D linked to ~32% lower myocardial flow reserve vs normoalbuminuria.
Why the study?
The relationship between myocardial flow reserve, coronary artery calcium, and albuminuria in patients with Type 1 diabetes was not well characterized.
Is myocardial flow reserve impaired in patients with Type 1 diabetes and microvascular complications compared to those without complications or non-diabetic controls?
Cross-Sectional (n=90)
Is myocardial flow reserve impaired in patients with Type 1 diabetes and microvascular complications compared to those without complications or non-diabetic controls?
Absolute Event Rate: 2.1% vs 3.1%
p-value: p=< 0.0001
Myocardial microvascular function is impaired in Type 1 diabetes patients with microvascular complications (macroalbuminuria and proliferative retinopathy) but comparable to non-diabetic controls in those without such complications.
Impaired MFR signals higher cardiac risk in Type 1 diabetes with macroalbuminuria; leaves open whether it refines prognosis beyond albuminuria.
AIMS: To evaluate myocardial flow reserve (MFR) and coronary artery calcium (CAC) in persons with Type 1 diabetes with or without albuminuria and in non-diabetic controls. MFR reflects the function of large epicardial arteries and myocardial microcirculation. CAC represents structural aspects of atherosclerosis. In addition, we evaluated the association of MFR and CAC with retinopathy, another microvascular complication. METHODS AND RESULTS: Cross-sectional study in Type 1 diabetes, stratified by normoalbuminuria (NORMO; n = 30) and macroalbuminuria (MACRO; n = 30), and in non-diabetic controls (n = 30). MFR (pharmacological stress flow/rest flow) was evaluated by cardiac 82Rb positron emission tomography/computed tomography. MFR was similar in patients with NORMO and controls (3.1 ± 0.79 vs. 3.0 ± 0.79; P = 0.74). Patients with MACRO had lower (impaired) MFR when compared with NORMO (2.1 ± 0.92 vs. 3.1 ± 0.79; P < 0.0001). The CAC score [median (interquartile range)] was higher in NORMO when compared with controls [72 (22-247) vs. 0 (0-81), P = 0.03], and comparable between MACRO and NORMO. MFR was comparable in patients with diabetes and simplex or no retinopathy (n = 24 and n = 12, 2.8 ± 0.84 vs. 3.3 ± 0.77, P = 0.11), but lower in proliferative (n = 24) compared with simplex retinopathy (2.1 ± 0.97 vs. 2.8 ± 0.84, P = 0.02). The CAC score was comparable between groups of retinopathy. CONCLUSION: Myocardial microvascular function was comparable in non-diabetic controls and patients with Type 1 diabetes and NORMO; but impaired in the presence of microvascular complications (MACRO and proliferative retinopathy). Coronary calcification was elevated in diabetes, however, not explained by albuminuria.
No takes yet. Share an insight, caveat, or question.
Zobel et al. (2018) conducted a cross-sectional in Type 1 diabetes (n=90). Macroalbuminuria vs. Normoalbuminuria was evaluated on Myocardial flow reserve (MFR) (p=< 0.0001). In patients with Type 1 diabetes, macroalbuminuria was associated with significantly impaired myocardial flow reserve compared to normoalbuminuria (2.1 vs. 3.1; P < 0.0001).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: