Pustaka Ilmiah Universitas Padjadjaran

Abstrak

The Correlation Between Transient Ischemic Dilation (TID) ratio with HbA1c value in Type 2 Diabetes Mellitus patients who also present with Metabolic Syndrome

Using myocardial perfusion scintigraphy (MPS), perfusion defects are often found in asymptomatic type 2 diabetes mellitus (T2DM) patients. Identification of these patients is very important. T2DM can cause diffuse atherosclerosis and coronary flow reserve abnormalities at the microvascular level, which is a potential cause of false negative results of MPS. One way to solve this problem is by observing the transient ischemic dilation (TID) ratio. High TID ratio in the presence of normal perfusion is often found and thought to be due to balanced ischemia. T2DM patients who also present with metabolic syndrome (MS) are often said to have worse glucose control, longer duration of disease, the presence of complications, and much higher risk for coronary artery disease (CAD) compared to patients with T2DM only. The increased risks for diabetes seem to be mediated through hemoglobin A1c (HbA1c) concentration. The aim of this study was to find out the relation of TID ratio with HbA1c in T2DM patients with or without MS. From August 2007 to March 2008, 48 T2DM patients with no/mild CAD symptoms underwent one day protocol MPS in our department. The stress tests were done by exercise using ergocycle. TID ratio was automatically measured by using Emory Cardiac Toolbox software (ECToolbox; Syntermed, Inc.). HbA1c concentration, waist circumference, and other factors that would be needed to confirm the diagnosis of MS were also measured. The mean value of TID ratio and HbA1c in T2DM with MS group were 1.12 + 0.14 and 7.96 + 2.47, while in T2DM without MS group were 1.05 + 0.13 and 8.77 + 2.83 % respectively. There was no correlation between the value of TID ratio and HbA1C in T2DM patients without considering MS. On the contrary, there was a statistically significant correlation between them in T2DM patients who also presented MS (T2DM with MS group) at the level of significance p < 0.05. One more interesting thing was that the incidence of high TID ratio without perfusion defect was higher in T2DM with MS compared to T2DM alone and all of the patients with this incidence had high HbA1c. The present study has shown that there is a good correlation between TID and HbA1c concentration in T2DM patients who present MS. Poor glucose control and MS are factors that are responsible for TID in T2DM. To increase the sensitivity of MPS in detecting CAD in T2DM patients with MS and poor glucose control, TID ratio measurement is recommended.