Microvascular Dysfunction in Patients With Type II Diabetes Mellitus: Invasive Assessment of Absolute Coronary Blood Flow and Microvascular Resistance Reserve

• DOI: 10.3389/fcvm.2021.765071
• Publication Date: 2021-10-20T22:27:37Z
• Authors: Emanuele Gallinoro; Pasquale Paolisso; Alessandro Candreva; Konstantinos Berm...; Davide Fabbricatore; Giuseppe Esposito; Dario Bertolone; Estefania Fernand...; Daniel Munhoz; Niya Mileva; Martin Penicka; Jozef Bartunek; Marc Vanderheyden; Eric Wyffels; Jeroen Sonck; Carlos Collet; Bernard De Bruyne; Emanuele Barbato
• Keywords: Coronary flow reserve; Fractional Flow Reserve; Coronary circulation; Endothelial Dysfunction

Background: Coronary microvascular dysfunction (CMD) is an early feature of diabetic cardiomyopathy, which usually precedes the onset diastolic and systolic dysfunction. Continuous intracoronary thermodilution allows accurate reproducible assessment absolute coronary blood flow resistance thus allowing evaluation reserve (CFR) Microvascular Resistance Reserve (MRR), a novel index specific for function, independent from myocardial mass. In present study we compared resistance, CFR MRR assessed by continuous in vs. non-diabetic patients. Left atrial reservoir strain (LASr), marker was between two groups. Methods: this observational retrospective study, 108 patients with suspected angina non-obstructive artery disease (NOCAD) consecutively undergoing elective angiography (CAG) September 2018 to June 2021 were enrolled. The invasive functional function performed left anterior descending (LAD) thermodilution. Patients classified according presence DM. Absolute resting hyperemic (in mL/min) WU) cohorts. FFR measured assess epicardial lesions, while calculated function. LAS, speckle tracking echocardiography, used detect structural changes potentially associated Results: median value 0.83 [0.79–0.87] without any significant difference similar Similarly, resistances did not change significantly DM cohort lower control group (CFR = 2.38 ± 0.61 2.88 0.82; 2.79 0.87 3.48 1.02 respectively, [p < 0.05 both]). Likewise, had reservoir, contractile conductive LAS (all p 0.05). Conclusions: Compared patients, arteries, both similar. LASr confirming subclinical microcirculatory impairment. thermodilution-derived indexes provide reliable operator-independent macro- microvasculature might facilitate widespread clinical adoption physiologic disease.