OBJECTIVE To examine differences in myocardial blood flow (MBF) at rest and during stress between patients with type 2 diabetes and control subjects, and to identify potential predictors of changes in MBF at rest and during stress. RESEARCH DESIGN AND METHODS A cross-sectional study was conducted of 193 patients with type 2 diabetes and 20 age- and sex-matched control subjects. Cardiovascular magnetic resonance was used to evaluate left ventricular structure and function and MBF at rest and during adenosine-induced stress. MBF was derived as the mean of the flow within all segments of a midventricular slice. RESULTS Patients with type 2 diabetes had higher global MBF at rest (0.81 ± 0.19 mL/min/g) and lower global MBF during stress (2.4 ± 0.9 mL/min/g) than control subjects (0.61 ± 0.11 at rest, 3.2 ± 0.8 mL/min/g under stress; both P < 0.01). Patients with macroalbuminuria had lower MBF during stress (1.6 ± 0.5 mL/min/g) than did patients with microalbuminuria (2.1 ± 0.7 mL/min/g; P = 0.04), who in turn had lower MBF during stress than did normoalbuminuric patients (2.7 ± 0.9 mL/min/g; P < 0.01). Patients with severe retinopathy had lower MBF during stress (1.8 ± 0.6 mL/min/g) than patients with simplex retinopathy (2.3 ± 0.7 mL/min/g; P < 0.05) and those who did not have retinopathy (2.6 ± 1.0 mL/min/g; P < 0.05). Albuminuria and retinopathy were associated with reduced MBF during stress in a multiple regression analysis. Stress-related MBF inversely correlated with myocardial extracellular volume (P < 0.001; R 2 = 0.37), a measure of diffuse myocardial fibrosis. A trend toward lower basal MBF was observed in patients treated with sodium-glucose cotransporter 2 inhibitors (P = 0.07). CONCLUSIONS Patients with type 2 diabetes have higher global MBF at rest and lower maximal MBF during vasodilator-induced stress than control subjects. Reduced MBF during stress is associated with diabetes complications (albuminuria and retinopathy) and is inversely correlated with diffuse myocardial fibrosis.

中文翻译：

---

2型糖尿病患者的心肌灌注储备减少是由于静息灌注增加和应激时最大灌注减少所致。

目的探讨2型糖尿病患者和对照组之间在静息时和应激时心肌血流（MBF）的差异，并确定静息时和应激时MBF变化的潜在预测因子。研究设计和方法对193名2型糖尿病患者和20名年龄和性别匹配的对照受试者进行了横断面研究。心血管磁共振用于评估静止和腺苷诱发的应激时左心室的结构和功能以及MBF。MBF推导为脑室中层所有片段内血流的平均值。结果2型糖尿病患者静息时的整体MBF（0.81±0.19 mL / min / g）较高，而应激时的全身MBF（2.4±0.9 mL / min / g）则比对照组（静息时0.61±0.11，3.2±在压力下为0.8 mL / min / g；均P <0.01）。患有白蛋白尿的患者在应激期间的MBF（1.6±0.5 mL / min / g）低于患有微量白蛋白尿的患者（2.1±0.7 mL / min / g; P = 0.04），后者在应激期间的MBF低于正常白蛋白尿患者（2.7±0.9 mL / min / g； P <0.01）。重度视网膜病变患者在应激期间的MBF（1.8±0.6 mL / min / g）低于单纯性视网膜病变患者（2.3±0.7 mL / min / g; P <0.05）和没有视网膜病变的患者（2.6±1.0 mL） / min / g； P <0.05）。在多元回归分析中，蛋白尿和视网膜病变与应激期间MBF降低有关。与应激有关的MBF与心肌细胞外体积呈负相关（P <0.001； R 2 = 0.37），这是弥漫性心肌纤维化的一种度量。在使用钠-葡萄糖共转运蛋白2抑制剂治疗的患者中观察到了基底MBF降低的趋势（P = 0.07）。结论与对照组相比，2型糖尿病患者在静息状态下的总MBF较高，而在血管舒张剂诱发的压力下的最大MBF较低。应激期间MBF降低与糖尿病并发症（白蛋白尿和视网膜病变）相关，并且与弥漫性心肌纤维化呈负相关。