Previous gestational diabetes history is associated with impaired coronary flow reserve

Figures & data

Table I. Demographic, clinical, and biochemical characteristics of the GDM group and the control group.

	p-GDM (n = 93)	Control (n = 95)	p Value
Age (years)	34 ± 5	33 ± 5	0.33
BMI (kg/m^2)	26.7 ± 3.5	26.1 ± 2.7	0.17
Waist circumference (cm)	85.1 ± 5.2	84.8 ± 5.1	0.47
Fasting glucose (mg/dL)	94 ± 7	92 ± 5	0.17
Fasting insulin (μU/mL)	11.7 ± 5.9	7.4 ± 3.8	<0.001
HOMA-IR	2.8 ± 1.4	1.7 ± 0.9	<0.001
HbA1c (%)	5.2 ± 0.4	5.0 ± 0.3	0.001
Total cholesterol (mg/dL)	189 ± 26	178 ± 30	0.04
LDL cholesterol (mg/dL)	118 ± 22	108 ± 27	0.02
HDL cholesterol (mg/dL)	45 ± 9	47 ± 10	0.36
Triglyceride (mg/dL)	130 ± 45	124 ± 56	0.62
GGT (U/L)	24 ± 10	19 ± 7	0.004
Uric acid (mg/dL)	4.8 ± 1.3	4.2 ± 1.4	0.003
HsCRP (mg/L)	3.1 ± 2.1	2.1 ± 2.1	0.004

BMI = body mass index; GGT = serum gamma-glutamyl transferase; HbA1c = hemoglobin A1c; HDL = high-density lipoprotein; HOMA-IR = homeostasis model assessment insulin resistance; HsCRP = high-sensitivity C-reactive protein; LDL = low-density lipoprotein.

Table II. Coronary flow reserve and echocardiographic measurements of the GDM group and the control group.

	p-GDM (n = 93)	Control (n = 95)	p Value
LA (mm)	33 (30–35)	30 (29–32)	0.006
IVS (mm)	8.95 ± 0.93	8.78 ± 0.99	0.23
PW (mm)	8.9 (8–9)	8 (8–9)	0.77
LVDD (mm)	45.2 ± 4.1	44.7 ± 3.5	0.39
LVSD (mm)	28.8 ± 6.2	28.6 ± 5.9	0.86
EF (%)	67.4 ± 4	65.3 ± 4.6	0.06
LVMI (g/m^2)	72.2 ± 14.2	69.3 ± 13.5	0.14
Mitral E wave max (cm/s)	80.2 ± 12.6	82.9 ± 10.3	0.11
Mitral A wave max (cm/s)	70.1 ± 12.8	62.5 ± 9.2	<0.001
E/A ratio	1.17 ± 0.21	1.33 ± 0.18	<0.001
EFT (mm)	5.5 ± 1.3	4.2 ± 1.1	<0.001
IVRT (ms)	104 ± 12	98 ± 13	0.007
Septal E' (cm/s)	11.8 ± 2.4	13.1 ± 3.1	0.01
Septal A' (cm/s)	11.4 ± 1.9	9.7 ± 1.4	<0.001
Septal E'/A' ratio	1.01 ± 0.27	1.35 ± 0.19	<0.001
Septal IVRT (ms)	94.3 ± 16.9	94.1 ± 13.9	0.95
Septal IVCT (ms)	52.8 ± 9.8	49.5 ± 8.7	0.01
MPI	0.55 ± 0.07	0.52 ± 0.07	0.04
E/E' ratio (mitral/septal)	7.21 ± 1.77	6.53 ± 1.38	0.03
Baseline SBP (mmHg)	121 ± 9	118 ± 11	0.11
Baseline heart rate (bpm)	76 ± 9	75 ± 7	0.03
Baseline DBP (mmHg)	76 ± 5	75 ± 8	0.25
Peak SBP (mmHg)	120 ± 9	117 ± 12	0.03
Peak heart rate (bpm)	103 ± 11	103 ± 9	0.98
Baseline DPFV (cm/s)	25.5 ± 5.3	23.4 ± 5.1	<0.001
Peak DPFV (cm/s)	58.5 ± 9.5	65.2 ± 14.5	<0.001
Baseline rate-pressure product	9103 ± 1324	8666 ± 1114	0.08
Peak rate-pressure	12363 ± 1579	12003 ± 1875	0.20
CFVR (ratio)	2.34 ± 0.39	2.83 ± 0.21	<0.001

A' = myocardial atrial peak velocity; bpm = beats per minute; CFVR = coronary flow velocity reserve; DPFV = coronary diastolic peak flow velocity of left anterior descending coronary artery; E' = myocardial early peak velocity; E/A ratio = maximum mitral E wave velocity/maximum mitral A wave velocity; EF = left ventricular ejection fraction; EFT = epicardial fat thickness; IVCT = isovolumetric contraction time; IVRT = isovolumic relaxation time; IVS = interventricular septum; LA = left atrial diameter; LVDD = left ventricular diastolic diameter; LVSD = left ventricular systolic diameter; MPI = myocardial performance index; PW = posterior wall.

Figure 1. CFVR values for the patients with GDM group and the control group.

Figure 2. Correlation analysis of CFVR, mitral E/septal E', epicardial fat thickness, and hemoglobin A1c.

Table III. Correlation between CFVR and the study variables in the control group and in the patients with gestational diabetes group.

	R	p Value
BMI (kg/m^2)	−0.035	0.63
Baseline SBP (mmHg)	−0.384	<0.001
EFT (mm)	−0.480	<0.001
HbA1c (%)	−0.688	<0.001
HOMA-IR	−0.395	<0.001
Fasting glucose (mg/dL)	−0.150	0.04
GGT (IU/L)	−0.239	0.006
Uric acid (mg/dL)	−0.299	<0.001
HsCRP (mg/L)	−0.382	<0.001
Total cholesterol (mg/dL)	−0.164	0.06
LDL cholesterol (mg/dL)	−0.151	0.09
HDL cholesterol (mg/dL)	0.058	0.45
Mitral E (cm/s)	0.241	0.006
Mitral A (cm/s)	−0.356	<0.001
Mitral E/A (ratio)	0.193	0.03
Septal E' (cm/s)	0.250	0.004
Septal A' (cm/s)	−0.297	<0.001
Septal E'/A' (ratio)	0.119	0.18
E/E' (ratio)	−0.325	<0.001
LVMI (g/m^2)	−0.131	0.14

A' = myocardial atrial peak velocity; BMI = body mass index; E' = myocardial early peak velocity; EFT = epicardial fat thickness; GGT = serum gamma-glutamyl transferase; HbA1c = hemoglobin A1c; HDL = high-density lipoprotein; HOMA-IR = homeostasis model assessment insulin resistance; HsCRP = high-sensitivity C-reactive protein; IVRT = isovolumic relaxation time; LDL = low-density lipoprotein; Mitral A = maximum mitral A wave velocity; Mitral E = maximum mitral E wave velocity.

Table IV. Multiple linear regression analyses for CFVR as a dependent variable.

Independent variable	B	SD (B)	p Value
Intercept	6.999	0.451	<0.001
Gestational diabetes (yes/no)	−0.238	0.074	0.002
Epicardial fat thickness (mm)	−0.044	0.021	0.056
HbA1c (%)	−0.460	0.076	<0.001
Baseline SBP (mmHg)	−0.008	0.003	0.008
E/E' ratio (mitral/septal)	−0.077	0.016	<0.001

B = regression coefficient; SD = standard deviation of regression coefficient;

HbA1c = hemoglobin A1c.