Subendocardial Viability Ratio (SEVR): A Potential Marker of Renal and/or Vascular Damage in Type 1 Diabetes (T1D)?

Prince, Catherine T.; Orchard, Trevor J.
June 2007
Diabetes;Jun2007 Supplement 1, Vol. 56, pA262
Academic Journal
Though aortic pressure and related measures have been associated with cardiovascular outcomes, little is known about how these measures predict other outcomes in T1D. The SEVR, the diastole to systole area ration under the aortic pressure curve, is an indicator of myocardial perfusion. As diabetes is associated with lower SEVR measures, we postulate that a lower SEVR may also relate to perfusion and vascular damage in other tissues. Cross-sectional data from the Pittsburgh Epidemiology of Diabetes Complications (EDC) study 18-year exam were thus related to albuminuria (a marker of renal/vascular damage). Arterial stiffness measures were taken by vascular applanation tonomentry (SphygmoCor; AtCor Medical, Sydney, Australia) and SEVR was calculated using the formulae: (Diastolic Time X Diastolic Pressure) / (Systolic Time X Systolic Pressure). Urinary albumin (mg/dL) to creatinine (mg/dL) (A/C) ratios were also obtained from a midmorning specimen. A total of 101 participants (mean age = 44; mean diabetes duration = 36 years), 48% of whom are female, had values for both measures and are included in this analysis. Females had significantly lower SEVR compared to males (p = .023) but A/C did not differ by sex. SEVR was negatively correlated with A/C (r = -0.42; p < .001), age (r = -0.34; p < .001), diabetes duration (r = -0.23; p = .02), systolic blood pressure (SBP) (r = -0.45; p < .001), and HbA1c (r = -0.215; p = .03), but not with diastolic blood pressure (DBP), body mass index (BMI), non-HDL or HDL cholesterol level. A multivariate model with these factors, as well as sex, showed only SBP and SEVR to be independent correlates of A/C at p < .001 and p = .009, respectively. Even in those with normal albuminuria levels (A/C<30), a significant negative correlation (r = -0.32; p = .008) was still present, and in the multivariate model, SEVR was the only independent predictor of A/C (p = .008). Although these are cross-sectional data, the results suggested a potential role for SEVR as an early marker of renal/vascular damage in T1D.


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