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SA JOURNAL OF DIABETES & VASCULAR DISEASE
RESEARCH ARTICLE
VOLUME 13 NUMBER 2 • DECEMBER 2016
79
may be caused by micro-angiopathy or endothelial dysfunction.
Accordingly, it reflects an increased likelihood of future coronary
events.
21
The majority of studies on ischaemia have used SPECT MPI. An
analysis of the diagnostic accuracy of pharmacologically induced
stress MPI reported a mean sensitivity and specificity of 88 and
77%, respectively.
22
Platelet volume is a marker of platelet activation and function,
and is measured using MPV.5 Platelets that have dense granules
are more active biochemically, functionally and metabolically. Large
platelets secrete high levels of prothrombogenic thromboxane A2,
serotonin, beta-thromboglobulin and procoagulant membrane
proteins such as P-selectin and glycoprotein IIIa.
5,23
Platelets
secrete a large number of substances that are crucial mediators of
coagulation, inflammation, thrombosis and atherosclerosis.
24,25
It is
also well known that large platelets are a risk factor for developing
coronary thrombosis, leading to myocardial infarction.
19,23,26,27
Measurement of platelet activation and/or aggregation may
provide prognostic information in patients at risk for or following
a cardiovascular event.
28,29
Reports have revealed that there is a
close relationship between MPV and cardiovascular risk factors,
including impaired fasting glucose levels, diabetes mellitus,
hypertension, hypercholesterolaemia, obesity and the metabolic
syndrome.
30-32
Increased platelet activity is reported to play a role in
the development of vascular complications in diabetic patients.
18
MPV was increased in patients with SCF complex and cardiac
syndrome X, both being related to microvascular defects and
endothelial dysfunction.
33,34
In the present study, we showed that
MPV was associated with myocardial perfusion defect, using MPI
in diabetic patients.
In our study, MPV was increased in the myocardial perfusion
defect group compared to those without myocardial perfusion
defects. DM not only involves the main coronary artery but also the
microvascular circulation, leading to myocardial perfusion defects.
Perfusion defects are significant predictors of coronary events in
patients with known or suspected CHD.
20
The main limitation of our study was the small sample size, which
could result in low statistical power for equivalency testing, leading
to false-negative results. Second, because of the retrospective
nature of data collection, the angiographic results of the patients
were not evaluated. MPI may reflect myocardial perfusion defects
but it was not able to show the anatomical status of the coronary
artery. We cannot extend our results to the general population due
to our broad exclusion criteria.
Conclusion
MPV levels were higher in the diabetic patients with myocardial
perfusion defects than in those without myocardial perfusion
defects. In diabetic patients, increased MPV may be an independent
marker of myocardial perfusion defects, which are associated with
adverse coronary events.
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Table 2.
Univariate and multivariate regression analyses of
independent variables for MPD.
Univariate Multivariate
Variables
OR 95% CI
p
-value OR 95% CI
p
-value
MPV (fl)
2.401 1.298–4.440 0.005 2.484 1.215–5.081 0.013
Glucose (mg/dl) 1.009 0.999–1.029 0.072 1.008 0.997–1.019 0.178
HbA
1c
(%)
1.800 0.993–3.474 0.08 1.984 0.980–4.018 0.064
Age (years)
1.011 0.963–1.061 0.664
Gender
1.244 0.497–3.16 0.641
HT (mg/dl)
2.375 0.801–7.043 0.119
BMI (km/m2)
0.991 0.92–1.067 0.820
TC (mg/dl)
0.994 0.984–1.004 0.256
TG (mg/dl)
0.998 0.994–1.002 0.360
HDL-C (mg/dl) 0.948 0.878–1.023 0.167
LDL (mg/dl)
0.989 0.975–1.003 0.134
Hb (%)
1.138 0.845–1.534 0.395