Serum asymmetric dimethylarginine as a marker of coronary microcirculation in patients with non-insulin dependent diabetes mellitus: correlation with coronary flow reserve

摘要

Abnormalities of coronary microcirculation without large vessel atherosclerosis have been known in patients with non-insulin dependent diabetes mellitus (NIDDM). Coronary flow reserve (CFR) has been considered an important physiological parameter in the coronary circulation reflecting the function of large epicardial arteries and the microcirculation, including endothelial function. Reduced CFR and impaired endothelium mediated, nitric oxide dependent coronary vasodilatation have been observed in NIDDM without overt coronary artery disease. Asymmetric dimethylarginine (ADMA) is a major endogenous nitric oxide synthase inhibitor and has been considered a novel risk factor of cardiovascular disease. Serum or plasma concentration of ADMA is increased in patients with NIDDM and may attenuate vascular function. However, to our knowledge, the relation between ADMA and CFR has not been examined in patients with NIDDM. Our goal was to examine the relation between serum ADMA concentration and CFR in patients with NIDDM by means of non-invasive transthoracic Doppler echocardiography.