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CLINICAL STUDIES

Coronary artery distensibility in diabetic patients with simultaneous measurements of luminal area and intracoronary pressure

Evidence of impaired reactivity to nitroglycerin

^a Department of Cardiology, Hipprokration Hospital, University of Athens, Athens, Greece

Manuscript received September 10, 1998; revised manuscript received May 5, 1999, accepted June 22, 1999.

Reprint requests and correspondence: Dr. Manolis Vavuranakis, Haimanda 24-26, Marousi 15122, Athens, Greece

OBJECTIVES

This study investigated whether noninsulin dependent diabetes mellitus (NIDDM) adversely affects the elastic properties of the coronary arteries in patients with coronary artery disease (CAD) and NIDDM.

BACKGROUND

Attenuated vascular smooth muscle dilation to exogenous donors of nitric oxide, such as nitroglycerin, has been observed with forearm blood flow studies in patients with NIDDM.

METHODS

Twenty patients with CAD and NIDDM (diabetics), and 20 patients with only CAD (nondiabetics) were evaluated. Intracoronary ultrasound (ICUS) imaging with simultaneous intracoronary pressure (P₂) recordings were performed at the imaging site with 0.014 in fiber-optic high fidelity pressure monitoring wire. The same wire was used as guide wire for the ICUS catheter. Sites with less than 50% luminal stenosis by ICUS were studied. Recordings were done before and after 300 µg of intracoronary nitroglycerin (IC-NTG). Electrocardiographic tracings recorded simultaneously with ICUS images were used for timing. Systolic and diastolic cross-sectional lumen area (CSLA) and coronary artery distensibility (C-DIST) were measured, C-DIST = {(systolic CSLA-diastolic CSLA)/[(intracoronary pulse pressure) x (diastolic CSLA)]} x 1,000.

RESULTS

Diabetics had smaller CSLA (diabetics = 8.6 ± 0.6 mm², nondiabetics = 11.5 ± 0.5 mm², p < 0.01). Although C-DIST was similar before IC-NTG in the two groups, it became significantly lower in diabetics after IC-NTG (diabetics C-DIST = 3.02 ± 0.14 mm Hg^–1, nondiabetics C-DIST = 4.21 ± 0.15 mm Hg^–1, p < 0.01). Degrees of circumference involved, total plaque burden and composition were similar in both groups.

CONCLUSIONS

Noninsulin dependent diabetes mellitus reduces C-DIST after IC-NTG administration.

Abbreviations and Acronyms   CAD = coronary artery disease   C-DIST = coronary artery distensibility   CSLA = cross-sectional lumen area   D-BP = diastolic intracoronary pressure   ECG = electrocardiographic tracings   IC-NTG = intracoronary nitroglycerin   ICUS = intracoronary ultrasound   NIDDM = noninsulin dependent diabetes mellitus   P1 = aortic pressure   P2 = intracoronary pressure   PTCA = percutaneous transluminal coronary angioplasty   S-BP = systolic intracoronary pressure

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