{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T05:06:54Z","timestamp":1790053614358,"version":"4.0.1"},"reference-count":32,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T00:00:00Z","timestamp":1790035200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"\n Objective<\/jats:title>\n Microvascular myocardial ischemia (MMI) in patients with T2DM may be influenced by the presence of concomitant obstructive coronary artery disease (OCAD). Our investigation focused on assessing the impact of OCAD on MMI and delineating the prognostic relevance of MMI.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n This study included four groups: (1) control group without OCAD (\n n<\/jats:italic>\n \u2009=\u2009125), (2) control group with OCAD (\n n<\/jats:italic>\n \u2009=\u200999); (3) T2DM patients without OCAD (\n n<\/jats:italic>\n \u2009=\u2009100); (4) T2DM patients with OCAD (\n n<\/jats:italic>\n \u2009=\u200993). All patients received dynamic computed tomography myocardial perfusion imaging (CT\u2013MPI) as well as coronary computed tomography angiography (CCTA). Univariate and multivariate linear regression analyses were performed to identify independent determinants of clinical characteristics and perfusion metrics related to MMI. Major adverse cardiovascular events (MACEs) were documented, and the prognostic significance of CT\u2013MPI compared with clinical variables was assessed.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n The myocardial blood flow (MBF) stepwise reduced from the control (OCAD\u2212), T2DM (OCAD\u2212), control (OCAD+) to T2DM (OCAD+) group (\n p<\/jats:italic>\n \u2009&lt;\u20090.05). Independent associations were observed between global MBF and OCAD or T2DM (OCAD:\n p<\/jats:italic>\n \u2009&lt;\u20090.05, R\n 2<\/jats:sup>\n \u2009=\u20090.154; T2DM:\n \u03b2<\/jats:italic>\n \u2009=\u2009\u221211.96,\n p<\/jats:italic>\n \u2009&lt;\u20090.001, R\n 2<\/jats:sup>\n \u2009=\u20090.101). A significant association was observed between OCAD and global MBF in the circumstance of T2DM (R\n 2<\/jats:sup>\n \u2009=\u20090.176). An independent association was observed between the global MBF and MACEs (\n p<\/jats:italic>\n \u2009&lt;\u20090.05).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n Dynamic CT\u2013MPI combined with CCTA demonstrated that the presence of OCAD in T2DM patients is associated with a greater occurrence of MMI. MBF emerged as a robust predictor of cardiovascular outcomes in this population.<\/jats:p>\n <\/jats:sec>","DOI":"10.3389\/fcvm.2026.1897324","type":"journal-article","created":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T04:24:42Z","timestamp":1790051082000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Incremental effect and risk association of obstructive coronary artery disease on microvascular myocardial ischemia in T2DM patients evaluated via CT myocardial perfusion"],"prefix":"10.3389","volume":"13","author":[{"given":"Wangshu","family":"Zhu","sequence":"first","affiliation":[{"name":"Department of Diagnostic and Interventional Radiology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yijia","family":"Xiong","sequence":"additional","affiliation":[{"name":"Department of Diagnostic and Interventional Radiology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yidong","family":"Jin","sequence":"additional","affiliation":[{"name":"Department of Diagnostic and Interventional Radiology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Runjianya","family":"Ling","sequence":"additional","affiliation":[{"name":"Department of Diagnostic and Interventional Radiology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Geng","family":"Gu","sequence":"additional","affiliation":[{"name":"Department of Diagnostic and Interventional Radiology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhihan","family":"Xu","sequence":"additional","affiliation":[{"name":"Siemens Healthineers China","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jian","family":"Ma","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yue-Hua","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Diagnostic and Interventional Radiology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,22]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"2742","DOI":"10.1161\/CIRCULATIONAHA.118.039100","article-title":"Cardiovascular risk and risk factor management in type 2 diabetes mellitus: a population-based cohort study assessing sex disparities","volume":"139","author":"Wright","year":"2019","journal-title":"Circulation"},{"key":"B2","doi-asserted-by":"publisher","first-page":"80","DOI":"10.1186\/1475-2840-9-80","article-title":"Comparison of the diagnostic performance of 64-slice computed tomography coronary angiography in diabetic and non-diabetic patients with suspected coronary artery disease","volume":"9","author":"Andreini","year":"2010","journal-title":"Cardiovasc Diabetol"},{"key":"B3","doi-asserted-by":"publisher","first-page":"1123","DOI":"10.1016\/j.metabol.2013.02.011","article-title":"Effects of prediabetes and diabetes on left ventricular and coronary microvascular functions","volume":"62","author":"Erdogan","year":"2013","journal-title":"Metab Clin Exp"},{"key":"B4","doi-asserted-by":"publisher","first-page":"108831","DOI":"10.1016\/j.diabres.2021.108831","article-title":"The impact of diabetes on heart failure development: the cardio-renal-metabolic connection","volume":"175","author":"Valensi","year":"2021","journal-title":"Diabetes Res Clin Pract"},{"key":"B5","doi-asserted-by":"publisher","first-page":"1387","DOI":"10.1016\/S0735-1097(03)00166-9","article-title":"Role of chronic hyperglycemia in the pathogenesis of coronary microvascular dysfunction in diabetes","volume":"41","author":"D Carli","year":"2003","journal-title":"J Am Coll Cardiol"},{"key":"B6","doi-asserted-by":"publisher","first-page":"1081","DOI":"10.3348\/kjr.2023.0297","article-title":"Microvascular myocardial ischemia in patients with diabetes without obstructive coronary stenosis and its association with angina","volume":"24","author":"Yu","year":"2023","journal-title":"Korean J Radiol"},{"key":"B7","doi-asserted-by":"publisher","first-page":"222","DOI":"10.1186\/s12933-022-01653-y","article-title":"Prognostic value of coronary microvascular dysfunction assessed by coronary angiography-derived index of microcirculatory resistance in diabetic patients with chronic coronary syndrome","volume":"21","author":"Zhang","year":"2022","journal-title":"Cardiovasc Diabetol"},{"key":"B8","doi-asserted-by":"publisher","first-page":"73","DOI":"10.1186\/s12968-020-00667-3","article-title":"Incremental prognostic value of coronary flow reserve determined by phase-contrast cine cardiovascular magnetic resonance of the coronary sinus in patients with diabetes mellitus","volume":"22","author":"Kato","year":"2020","journal-title":"J Cardiovasc Magn Reson"},{"key":"B9","doi-asserted-by":"publisher","first-page":"326","DOI":"10.1148\/radiol.2021204192","article-title":"Diagnostic value of extracellular volume quantification and myocardial perfusion analysis at CT in cardiac amyloidosis","volume":"300","author":"Deux","year":"2021","journal-title":"Radiology"},{"key":"B10","doi-asserted-by":"publisher","first-page":"11945","DOI":"10.1136\/bmj.l1945","article-title":"Diagnosis of obstructive coronary artery disease using computed tomography angiography in patients with stable chest pain depending on clinical probability and in clinically important subgroups: meta-analysis of individual patient data","volume":"365","author":"Haase","year":"2019","journal-title":"Br Med J"},{"key":"B11","doi-asserted-by":"publisher","first-page":"305","DOI":"10.1148\/radiol.2019190098","article-title":"Detection of hemodynamically significant coronary stenosis: cT myocardial perfusion versus machine learning CT fractional flow reserve","volume":"293","author":"Li","year":"2019","journal-title":"Radiology"},{"key":"B12","doi-asserted-by":"publisher","first-page":"689","DOI":"10.1148\/radiol.11110638","article-title":"Detection of hemodynamically significant coronary artery stenosis: incremental diagnostic value of dynamic CT-based myocardial perfusion imaging","volume":"260","author":"Bamberg","year":"2011","journal-title":"Radiology"},{"key":"B13","doi-asserted-by":"publisher","first-page":"S14","DOI":"10.2337\/dc20-S002","article-title":"Classification and diagnosis of diabetes: standards of medical care in diabetes\u20142020","volume":"43","year":"2020","journal-title":"Diabetes Care"},{"key":"B14","doi-asserted-by":"publisher","first-page":"1445","DOI":"10.1016\/j.jcin.2015.06.017","article-title":"Prevalence of coronary microvascular dysfunction among patients with chest pain and nonobstructive coronary artery disease","volume":"8","author":"Sara","year":"2015","journal-title":"JACC Cardiovasc Interv"},{"key":"B15","doi-asserted-by":"publisher","first-page":"97","DOI":"10.3348\/kjr.2020.0249","article-title":"Dynamic CT myocardial perfusion imaging in patients without obstructive coronary artery disease: quantification of myocardial blood flow according to varied heart rate increments after stress","volume":"22","author":"Yu","year":"2021","journal-title":"Korean J Radiol"},{"key":"B16","doi-asserted-by":"publisher","first-page":"1168","DOI":"10.1007\/s00330-010-1715-9","article-title":"Dynamic myocardial stress perfusion imaging using fast dual-source CT with alternating table positions: initial experience","volume":"20","author":"Bamberg","year":"2010","journal-title":"Eur Radiol"},{"key":"B17","doi-asserted-by":"publisher","first-page":"539","DOI":"10.1161\/hc0402.102975","article-title":"Standardized myocardial segmentation and nomenclature for tomographic imaging of the heart. A statement for healthcare professionals from the cardiac imaging committee of the council on clinical cardiology of the American Heart Association","volume":"105","author":"Cerqueira","year":"2002","journal-title":"Circulation"},{"key":"B18","doi-asserted-by":"publisher","first-page":"e220183","DOI":"10.1148\/ryct.220183","article-title":"CAD-RADS\u2122 2.0\u20132022 coronary artery disease\u2014reporting and data system: an expert consensus document of the society of cardiovascular computed tomography (SCCT), the American College of Cardiology (ACC), the American college of radiology (ACR) and the North America society of cardiovascular imaging (NASCI)","volume":"4","author":"Cury","year":"2022","journal-title":"Radiol Cardiothorac Imaging"},{"key":"B19","doi-asserted-by":"publisher","first-page":"7252","DOI":"10.1158\/1078-0432.CCR-04-0713","article-title":"X-tile: a new bio-informatics tool for biomarker assessment and outcome-based cut-point optimization","volume":"10","author":"Camp","year":"2004","journal-title":"Clin Cancer Res"},{"key":"B20","doi-asserted-by":"publisher","first-page":"H1339","DOI":"10.1152\/ajpheart.00458.2015","article-title":"Coronary microvascular dysfunction after long-term diabetes and hypercholesterolemia","volume":"311","author":"Sorop","year":"2016","journal-title":"Am J Physiol Heart Circ Physiol"},{"key":"B21","doi-asserted-by":"publisher","first-page":"22","DOI":"10.1186\/s12933-019-0833-1","article-title":"Coronary microvascular dysfunction is associated with poor glycemic control amongst female diabetics with chest pain and non-obstructive coronary artery disease","volume":"18","author":"Sara","year":"2019","journal-title":"Cardiovasc Diabetol"},{"key":"B22","doi-asserted-by":"publisher","first-page":"33","DOI":"10.1186\/s12933-017-0513-y","article-title":"The nuclear factor (erythroid-derived 2)-like 2 (Nrf2) activator dh404 protects against diabetes-induced endothelial dysfunction","volume":"16","author":"Sharma","year":"2017","journal-title":"Cardiovasc Diabetol"},{"key":"B23","doi-asserted-by":"publisher","first-page":"887","DOI":"10.1093\/ehjci\/jez266","article-title":"Cardiac perfusion, structure, and function in type 2 diabetes mellitus with and without diabetic complications","volume":"21","author":"Sorensen","year":"2020","journal-title":"Eur Heart J Cardiovasc Imaging"},{"key":"B24","doi-asserted-by":"publisher","first-page":"301","DOI":"10.1016\/j.jcct.2016.05.005","article-title":"Dynamic CT myocardial perfusion imaging identifies early perfusion abnormalities in diabetes and hypertension: insights from a multicenter registry","volume":"10","author":"Vliegenthart","year":"2016","journal-title":"J Cardiovasc Comput Tomogr"},{"key":"B25","doi-asserted-by":"publisher","first-page":"587","DOI":"10.1136\/hrt.2009.183327","article-title":"Non-invasive\/invasive imaging: significance and assessment of coronary microvascular dysfunction","volume":"97","author":"Leung","year":"2011","journal-title":"Heart"},{"key":"B26","doi-asserted-by":"publisher","first-page":"154","DOI":"10.1186\/s12933-023-01873-w","article-title":"Incremental effect of coronary obstruction on myocardial microvascular dysfunction in type 2 diabetes mellitus patients evaluated by first-pass perfusion CMR study","volume":"22","author":"Wang","year":"2023","journal-title":"Cardiovasc Diabetol"},{"key":"B27","doi-asserted-by":"publisher","first-page":"142","DOI":"10.1016\/j.ijcard.2021.04.055","article-title":"Prevalence and disease features of myocardial ischemia with non-obstructive coronary arteries: insights from a dynamic CT myocardial perfusion imaging study","volume":"334","author":"Xu","year":"2021","journal-title":"Int J Cardiol"},{"key":"B28","doi-asserted-by":"publisher","first-page":"1065","DOI":"10.1093\/ehjci\/jev106","article-title":"Impact of diabetes duration on the extent and severity of coronary atheroma burden and long-term clinical outcome in asymptomatic type 2 diabetic patients: evaluation by coronary CT angiography","volume":"16","author":"Kim","year":"2015","journal-title":"Eur Heart J Cardiovasc Imaging"},{"key":"B29","doi-asserted-by":"publisher","first-page":"1292","DOI":"10.1016\/j.jcmg.2016.01.040","article-title":"Long-term prognostic value of coronary CT angiography in asymptomatic type 2 diabetes mellitus","volume":"9","author":"Kang","year":"2016","journal-title":"JACC Cardiovasc Imaging"},{"key":"B30","doi-asserted-by":"publisher","first-page":"609","DOI":"10.1016\/j.jdiacomp.2018.03.003","article-title":"Longer diabetes duration reduces myocardial blood flow in remote myocardium assessed by dynamic myocardial CT perfusion","volume":"32","author":"Tomizawa","year":"2018","journal-title":"J Diabetes Complications"},{"key":"B31","doi-asserted-by":"publisher","first-page":"111063","DOI":"10.1016\/j.ejrad.2023.111063","article-title":"Prognostic value of coronary CT angiography and CT myocardial perfusion imaging among patients with and without diabetes","volume":"167","author":"Xue","year":"2023","journal-title":"Eur J Radiol"},{"key":"B32","doi-asserted-by":"publisher","first-page":"525","DOI":"10.1007\/s00330-020-07145-5","article-title":"Diagnostic performance of quantitative, semi-quantitative, and visual analysis of dynamic CT myocardial perfusion imaging: a validation study with invasive fractional flow reserve","volume":"31","author":"Li","year":"2021","journal-title":"Eur Radiol"}],"container-title":["Frontiers in Cardiovascular Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2026.1897324\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T04:24:43Z","timestamp":1790051083000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2026.1897324\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,22]]},"references-count":32,"alternative-id":["10.3389\/fcvm.2026.1897324"],"URL":"https:\/\/doi.org\/10.3389\/fcvm.2026.1897324","relation":{},"ISSN":["2297-055X"],"issn-type":[{"value":"2297-055X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,22]]},"article-number":"1897324"}}