Quantitative Perfusion

1357617 - Sex-specific Predictors of Coronary Microvascular Function in a Cohort of Asymptomatic People With Type 2 Diabetes

Wednesday, January 25, 2023

Location: E-POSTER

Presenting Author(s)

JY

Jian L. Yeo, MB

Clinical research fellow
University of Leicester, United Kingdom

Primary Author(s)

JY

Jian L. Yeo, MB

Clinical research fellow
University of Leicester, United Kingdom

Co-Author(s)

Gaurav S. Gulsin, PhD

Academic clinical lecturer
University of Leicester
Leicester, England, United Kingdom
AD

Abhishek Dattani, MBBS

Clinical Research Fellow
University of Leicester, United Kingdom
AM

Anna-Marie Marsh, PhD

Chief cardiac physiologist
University of Leicester
Leicester, England, United Kingdom
MS

Manjit Sian, BSc

Chief cardiac physiologist
University of Leicester, United Kingdom
EB

Emer M. Brady, PhD

Post-doctoral research fellow
University of Leicester
Leicester, England, United Kingdom
HX

Hui Xue, PhD

Director, Imaging AI Program
National Institutes of Health
Bethesda, Maryland, United States
PK

Peter Kellman, PhD

Senior Scientist
National Institutes of Health, Maryland, United States
Gerry P. McCann, MD

NIHR research professor
University of Leicester
Leicester, England, United Kingdom

Disclosure(s):

Gerry P. McCann, MD: No financial relationships to disclose

Background: Type 2 diabetes (T2D) confers 10% higher relative risk of heart failure in women than men, which may be linked to higher prevalence of coronary microvascular dysfunction. We aimed to determine the prevalence and sex-specific determinants of coronary microvascular dysfunction in asymptomatic people with T2D.

Methods: We prospectively enrolled a multi-ethnic cohort of people with T2D and no evidence of cardiovascular disease and sex- and ethnicity-matched non-diabetic controls. Participants underwent echocardiography and stress perfusion cardiac MRI. Quantitative myocardial blood flow analysis was performed for measurement of myocardial perfusion reserve (MPR), an index of microvascular function. Multivariable linear regression was undertaken to identify the independent clinical and imaging predictors of MPR in people with T2D.

Results: Excluding participants with silent myocardial infarction (n=7), we included 455 with T2D (42% women, age 57 ± 11y, BMI 32 ± 6 kg/m²) and 88 non-diabetic controls (43% women, age 52 ± 12y, BMI 25 ± 4 kg/m²). Women and men with T2D had increased LV concentricity, systolic, and diastolic dysfunction. MPR was significantly lower in T2D than controls (2.9 ± 0.9 vs 3.5 ± 1.1, p< 0.001) and lower in diabetic women than men (2.7 ± 0.9 vs 3.0 ± 0.9, p< 0.001). A greater proportion of women with T2D had MPR of < 2.5 (45% vs 28%, p< 0.001). In a regression model adjusting for clinical risk factors, only age (β= -0.184, p=0.004), female sex (β= -0.210, p< 0.001) and systolic blood pressure (SBP) (β=-0.119, p=0.021) were independently associated with MPR in T2D. Sex-stratified analysis showed independent associations with MPR: age (β= -0.221, p=0.022), SBP (β= -0.122, p=0.131), and BMI (β = -0.188, p=0.026) in women, and age (β= -0.150, p=0.085) and SBP (β= -0.155, p=0.027) in men. Imaging measures of LV concentricity, filling pressure, and diffuse fibrosis did not independently predict MPR in T2D.

Conclusion: Age and systolic blood pressure are independent predictors of MPR in people with T2D. BMI is an additional independent risk factor for MPR in women but not men. Early interventions focussed on blood pressure reduction and weight loss, may prevent coronary microvascular dysfunction.