Early Noninvasive Detection of Myocardial Microbascular Dysfunction in Diabetes

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DESCRIPTION (provided by applicant): The purpose of this proposal is to foster the scientific development of Angela Taylor, M.D. as she develops an independent clinical research career. The University of Virginia will provide Dr. Taylor with the ideal setting under the mentorship of Dr. Christopher Kramer in which to investigate the imaging and treatment of early coronary artery disease in diabetes. Type II diabetes has become an epidemic in the United States. Death from cardiovascular disease is 2 to 4 fold the general population. Recent trials have demonstrated that traditional risk factors alone are not completely predictive of disease burden as measured with current noninvasive imaging technology particularly early in the disease process. Overt coronary artery disease is preceded by abnormalities in myocardial microvascular function and nonocclusive plaque accumulation in the artery wall both of which can be measured invasively. It has been shown that risl< factors associated with diabetes and the metabolic syndrome predict invasive measurements. However, current noninvasive technology does not have the ability to reliably measure these early abnormalities. Cardiac Magnetic Resonance (CMR) provides a noninvasive technology capable of directly assessing microvascular function within the heart. Our preliminary data shows a reduction of microvascular function in diabetes prior to overt coronary stenoses as compared to controls. The purpose of this study will be to demonstrate that CMR can reliably diagnose early nonocclusive coronary artery disease. Subject will undergo risk factor measurement, direct imaging of the artery wall with intravascular ultrasound, and noninvasive measurement of microvascular function with CMR. Specific aims include demonstrating that risk factors for coronary artery disease predict invasive and noninvasive measurements, that improvements in risk factors result in improvements in invasive and noninvasive measurements, and that CMR predicts invasive findings. RELEVANCE (See instructions): An eariier noninvasive mechanism of detection of cardiovascular disease will provide the potential to determine which risk factors have the greatest effect early in the disease process thus tailoring therapy and reducing costs, to offer a safer diagnostic mechanism, and to treat coronary disease eariier preventing future events thus contributing to significant improvements in public health. (End of Abstract)