Correlation of the severity of diabetic retinopathy and the heart muscle perfusion in patients with type 2 diabetes Wiesław Tryniszewski a, ⁎, Jarosław Kuśmierczyk b , Zbigniew Maziarz a , Roman Goś b , Dimitri P. Mikhailidis c , Maciej Banach d, ⁎, Jacek Rysz e , Konrad Pesudovs f a Department of Radiological and Isotopic Diagnostics and Therapy, Medical University of Lodz, Poland b Department of Ophthalmology and Sight Rehabilitation, Medical University of Lodz, Poland c Department of Clinical Biochemistry, Royal Free Campus, University College London Medical School, University College London, London, UK d Department of Hypertension, Medical University of Lodz, Poland e Department of Nephrology, Hypertension and Family Medicine, Medical University of Lodz, Poland f NH&MRC Centre for Clinical Eye Research, Flinders University and Flinders Medical Centre, Australia abstract article info Article history: Received 11 January 2009 received in revised form 8 February 2011 accepted 15 February 2011 Available online 24 March 2011 Keywords: Diabetic retinopathy Diabetes Heart muscle Risk factor Objective: The objective was to investigate whether microvascular disturbances in patients with type 2 diabetes (DM) as defined by retinal examination predict the existence of macrovascular disturbances found on radioisotopic perfusion examinations of the heart muscle. Materials and methods: A total of 100 patients with type 2 DM and an additional cardiovascular risk factor were enrolled in the study. All patients underwent comprehensive ophthalmologic examination, including fundus color photography and fluorescein angiography, and were divided into three groups: group 1 (NoDR): met the inclusion criteria but had no diabetic retinopathy; group 2 (NPDR): had signs of nonproliferative diabetic retinopathy; group 3 (PDR): had signs of preproliferative or proliferative diabetic retinopathy. After collecting general medical history and clinical data, patients underwent heart muscle perfusion studies. All patients followed a 48-h protocol heart muscle perfusion examination in the rest state as well as after the standardized exercise test. Single photon emission computed tomography examination was performed. Results: In the PDR group, the impairment of the heart muscle perfusion at stress and rest was more frequent than in the NPDR and NoDR groups. Analysis of the heart muscle perfusion results for the three groups showed a significant relationship with the severity of microvascular complications observed in eye fundus examinations. Conclusions: Comprehensive ophthalmologic assessment of the progression of diabetic retinopathy in patients with type 2 DM may be an indicator of heart muscle perfusion disturbance. © 2011 Elsevier Inc. All rights reserved. 1. Introduction Diabetes mellitus (DM) and its complications are important therapeutic problems. The early recognition and treatment of the type 2 DM vascular complications such as angiopathy, diabetic retinopathy and muscle perfusion disturbances are important for improving outcomes (Marshall & Flyvbjerg, 2006). Definitive tests of heart muscle perfusion which include radioisotopic examinations [single photon emission computed tomography (SPECT)] at rest and stress are relatively invasive methods and are used with restricted clinical indications (Anand, Lim, Lahiri, & Bax, 2006; Avogaro et al., 2007; Tryniszewski et al., 2010). Therefore, calls have been made for improved methods of identifying diabetic individuals at risk of coronary artery disease (Bax et al., 2007). Definitive testing for diabetic retinopathy is noninvasive (comprehensive ophthalmologic examination), and recent studies have suggested that the presence of diabetic retinopathy may be predictive of heart muscle perfusion disturbance (Cheung et al., 2007; Yoon et al., 2001). The aim of the study was to identify the relationship between micro- and macrovascular disturbances in terms of diabetic retino- pathy and cardiac nonperfusion in patients with type 2 DM and, specifically, to identify whether there is a correlation between the severity of retinal signs and heart muscle perfusion disturbance. 2. Material and methods A total of 100 patients with type 2 DM, age 36–74 years (mean age, 60.35±8.12 years) (44 women and 56 men), were enrolled for the study. The duration of type 2 DM was 10–26 years (mean, 16.9±4.5 years). Journal of Diabetes and Its Complications 25 (2011) 253–257 ⁎ Corresponding author. Department of Radiological and Isotopic Diagnostics and Therapy, Medical University of Lodz, Poland, WAM University Hospital in Lodz, Poland, 90-549 Lodz, Poland. E-mail address: wieslaw.tryniszewski@umed.lodz.pl (W. Tryniszewski). 1056-8727/$ – see front matter © 2011 Elsevier Inc. All rights reserved. doi:10.1016/j.jdiacomp.2011.02.003 Contents lists available at ScienceDirect Journal of Diabetes and Its Complications journal homepage: WWW.JDCJOURNAL.COM