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Serum asymmetric dimethylarginine as a marker of coronary microcirculation in patients with non-insulin dependent diabetes mellitus: correlation with coronary flow reserve
  1. T Kawata1,
  2. M Daimon1,
  3. R Hasegawa1,
  4. K Teramoto1,
  5. T Toyoda1,
  6. T Sekine1,
  7. K Yamamoto2,
  8. D Uchida2,
  9. T Himi2,
  10. K Yoshida1,
  11. I Komuro1
  1. 1Department of Cardiovascular Science and Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
  2. 2Kimitsu Chuo Hospital, Chiba, Japan
  1. Correspondence to:
    Professor Issei Komuro
    Department of Cardiovascular Science and Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba-shi, Chiba 260-8670, Japan;

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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 vasodilatation1,2 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.3 Serum or plasma concentration of ADMA is increased in patients with NIDDM3 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.


We studied 47 patients with NIDDM without a history of cardiovascular disease. We limited our study population to non-smokers and patients treated with diet or oral hypoglycaemic agents alone. All patients underwent two dimensional echocardiography and a treadmill exercise test …

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