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Master Thesis

Microcirculation coronaire et diabète : recherche d'une association entre microangiopathie diabétique et microcirculation coronaire au moyen de deux techniques nouvelles : l'IRM cardiaque de perfusion et la scintigraphie myocardique

Abstract : Context: the microangiopathic damages of diabetic subject no longer needs to be proven but diabetic cardiac microangiopathy is little known. We evaluated the cardiac microcirculatory impairment of diabetics according to the presence of peripheral microangiopathy. For this purpose, we used myocardial perfusion MRI, which is commonly used in our centre. Materials and methods: this is a monocentric, retrospective cohort study conducted at the Bordeaux University Hospital. Our population consisted of diabetic patients diagnosed for at least five years and without manifest coronary artery disease. Two groups were formed according to the presence of peripheral microangiopathy. 51 patients were included between January 2014 and October 2019 and underwent cardiac MRI with measurement of the myocardial perfusion reserve index (MPRI). Amongst them, 18 patients also underwent coronary flow reserve (CFR) assessment by CZT-SPECT camera. Results: our population was 75% male with a mean age of 66 years. The 2 groups were comparable on the main confounding factors (hypertension, obesity, left ventricular mass index, LVEF). The MPRI was calculated for each myocardial segment as the ratio of the maximum slope of signal intensity at adenosine stress to rest. 305 segments in the microangiopathy group were compared to 309 segments in the group without microangiopathy. Some segments were excluded or could not be assessed due to technical limitations. Patients in the microangiopathy group had a lower mean MPRI of -0.361 (1.98 vs 2.34, 95% CI [-0.747; 0.026], p=0.06) than patients without microangiopathy. Dynamic SPECT analysis also showed a decrease in global CFR in the microangiopathy group (2.63 vs 2.91, p=0.27). Conclusion : diabetic patients with peripheral microangiopathy have an alteration in myocardial perfusion that should be potentially related to authentic diabetic cardiac microangiopathy. Absolute quantification of myocardial blood flow and CFR is possible by using CZT-SPECT.
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Master Thesis
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Submitted on : Thursday, June 11, 2020 - 11:08:59 AM
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Alexis Barison. Microcirculation coronaire et diabète : recherche d'une association entre microangiopathie diabétique et microcirculation coronaire au moyen de deux techniques nouvelles : l'IRM cardiaque de perfusion et la scintigraphie myocardique. Sciences du Vivant [q-bio]. 2020. ⟨dumas-02864641⟩

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