Poor Glycemic Control Correlates with Worse Myocardial Flow Measured by Ammonia-13 Positron Emission Tomography in Cardiac Transplant Recipients

N. Wan, M. Travin, A. Luke, C. Gjelaj, A. Paschenko, O. Saeed, D. B. Sims, J. Shin, S. Vukelic, S. Murthy, P. Chavez, S. R. Patel, U. P. Jorde

Research output: Contribution to journalArticle

Abstract

PURPOSE: Increased hemoglobin A1C was reported to be a predictor of angiographically detected CAV. Our study examined the impact of glycemic control on myocardial blood flow (MBF) measured by 13N-ammonia positron emission tomography (PET) in transplant recipients. METHODS: We reviewed the records of patients who had heart transplant in the past 5 years at our center, and who had regadenoson-stress 13N-ammonia PET imaging. Three PET flow parameters were measured: stress MBF, myocardial flow reserve (MFR), and coronary vascular resistance (CVR = systolic blood pressure / stress MBF). Age, time from heart transplant to PET imaging, cold ischemia time during transplant, history of ≥ 2R cellular rejection, cholesterol level and A1C within 3 months of PET were recorded as potential risk factors. Correlations between PET and potential risk factors were analyzed (Pearson and Spearman's rank). Mann-Whitney test was used to compare PET flow between patients with A1C < 6.5% and A1C ≥ 6.5%. RESULTS: 57 patients (median age 57.6 years, 73% men) were identified. Median time from transplant to PET imaging was 25 months. Median stress MBF was 2.8 (2.3-3.2) ml/min/g, CVR was 46.7 (39.1-54.0) mmHg/ml/min/g, and MFR was 3.0 (2.6-3.6). A1C (median 6.4%) correlated significantly with stress MBF: r -0.395 (P 0.006), and with CVR: r 0.392 (P 0.006). Time from transplant to PET imaging showed weaker correlation with stress MBF: r -0.284 (p 0.032) and CVR: r 0.279 (p 0.035). Patients with A1C < 6.5% had significantly higher stress MBF (median 3.0 VS. 2.4, P 0.002), and lower CVR (median 42.1 VS. 52.8, P 0.022) compared to patients with A1C ≥ 6.5% (Fig. 1). MFR was also higher in patients with A1C < 6.5% (3.3 VS. 2.8, P 0.079), although not significant. CONCLUSION: Time from heart transplant and A1C level significantly correlated with MBF by 13N-ammonia PET. Patients with high HbA1C level had significantly lower MBF, suggesting that glycemic control may have an important role in prevention of CAV.

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine
  • Transplantation

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