Unveiling Myocardial Microstructure Shifts: Exploring the Impact of Diabetes in Stable CAD Patients Through CMR T1 Mapping

Overview

Journal Diabetol Metab Syndr

Publisher Biomed Central

Specialty Endocrinology

Date 2024 Jul 9

PMID 38982515

Authors

Gustavo Andre Boeing Boros

Whady Hueb

Paulo Cury Rezende

Carlos Eduardo Rochitte

Cesar Higa Nomura

Eduardo Gomes Lima

Matheus de Oliveira Laterza Ribeiro

Anderson Roberto Dallazen

Rosa Maria Rahmi Garcia

Jose Antonio Franchini Ramires

Roberto Kalil-Filho

Affiliations

Soon will be listed here.

Abstract

Background: This study investigates myocardial structural changes in stable coronary artery disease (CAD) patients with type 2 diabetes (T2D) using cardiac magnetic resonance (CMR) strain and T1 mapping.

Methods: A total of 155 stable CAD patients underwent CMR examination, including left ventricular (LV) morphology and function assessment, late gadolinium enhancement (LGE), and feature tracking (CMR-FT) for LV global longitudinal, circumferential, and radial strain. T1 mapping with extracellular volume (ECV) evaluation was also performed.

Results: Among the enrolled patients, 67 had T2D. Diabetic patients exhibited impaired LV strain and higher ECV compared to non-diabetics. Multivariate analysis identified T2D as an independent predictor of increased ECV and decreased strain.

Conclusions: CMR-based strain and T1 mapping highlighted impaired myocardial contractility, elevated ECV, and potential interstitial fibrosis in diabetic patients with stable CAD. This suggests a significant impact of diabetes on myocardial health beyond CAD, emphasizing the importance of a comprehensive assessment in these individuals.

Trial Registration: http://www.controlled-trials.com/ISRCTN09454308.

References

Kannel W, Hjortland M, CASTELLI W . Role of diabetes in congestive heart failure: the Framingham study. Am J Cardiol. 1974; 34(1):29-34. DOI: 10.1016/0002-9149(74)90089-7. View

Schulz-Menger J, Bluemke D, Bremerich J, Flamm S, Fogel M, Friedrich M . Standardized image interpretation and post-processing in cardiovascular magnetic resonance - 2020 update : Society for Cardiovascular Magnetic Resonance (SCMR): Board of Trustees Task Force on Standardized Post-Processing. J Cardiovasc Magn Reson. 2020; 22(1):19. PMC: 7066763. DOI: 10.1186/s12968-020-00610-6. View

Dei Cas A, Khan S, Butler J, Mentz R, Bonow R, Avogaro A . Impact of diabetes on epidemiology, treatment, and outcomes of patients with heart failure. JACC Heart Fail. 2015; 3(2):136-45. DOI: 10.1016/j.jchf.2014.08.004. View

Bojer A, Sorensen M, Madsen S, Broadbent D, Plein S, Gaede P . The independent association of myocardial extracellular volume and myocardial blood flow with cardiac diastolic function in patients with type 2 diabetes: a prospective cross-sectional cohort study. Cardiovasc Diabetol. 2023; 22(1):78. PMC: 10067250. DOI: 10.1186/s12933-023-01804-9. View

Joshi M, Kotha S, Malireddy S, Selvaraju V, Satoskar A, Palesty A . Conundrum of pathogenesis of diabetic cardiomyopathy: role of vascular endothelial dysfunction, reactive oxygen species, and mitochondria. Mol Cell Biochem. 2013; 386(1-2):233-49. DOI: 10.1007/s11010-013-1861-x. View

Mason T, Coelho-Filho O, Verma S, Chowdhury B, Zuo F, Quan A . Empagliflozin Reduces Myocardial Extracellular Volume in Patients With Type 2 Diabetes and Coronary Artery Disease. JACC Cardiovasc Imaging. 2021; 14(6):1164-1173. DOI: 10.1016/j.jcmg.2020.10.017. View

Storz C, Hetterich H, Lorbeer R, Heber S, Schafnitzel A, Patscheider H . Myocardial tissue characterization by contrast-enhanced cardiac magnetic resonance imaging in subjects with prediabetes, diabetes, and normal controls with preserved ejection fraction from the general population. Eur Heart J Cardiovasc Imaging. 2017; 19(6):701-708. DOI: 10.1093/ehjci/jex190. View

Diao K, Yang Z, Xu H, Liu X, Zhang Q, Shi K . Histologic validation of myocardial fibrosis measured by T1 mapping: a systematic review and meta-analysis. J Cardiovasc Magn Reson. 2016; 18(1):92. PMC: 5154013. DOI: 10.1186/s12968-016-0313-7. View

Sibley C, Noureldin R, Gai N, Nacif M, Liu S, Turkbey E . T1 Mapping in cardiomyopathy at cardiac MR: comparison with endomyocardial biopsy. Radiology. 2012; 265(3):724-32. PMC: 3504318. DOI: 10.1148/radiol.12112721. View

10.

Moon J, Messroghli D, Kellman P, Piechnik S, Robson M, Ugander M . Myocardial T1 mapping and extracellular volume quantification: a Society for Cardiovascular Magnetic Resonance (SCMR) and CMR Working Group of the European Society of Cardiology consensus statement. J Cardiovasc Magn Reson. 2013; 15:92. PMC: 3854458. DOI: 10.1186/1532-429X-15-92. View

11.

Erley J, Genovese D, Tapaskar N, Alvi N, Rashedi N, Besser S . Echocardiography and cardiovascular magnetic resonance based evaluation of myocardial strain and relationship with late gadolinium enhancement. J Cardiovasc Magn Reson. 2019; 21(1):46. PMC: 6686365. DOI: 10.1186/s12968-019-0559-y. View

12.

Low Wang C, Hess C, Hiatt W, Goldfine A . Clinical Update: Cardiovascular Disease in Diabetes Mellitus: Atherosclerotic Cardiovascular Disease and Heart Failure in Type 2 Diabetes Mellitus - Mechanisms, Management, and Clinical Considerations. Circulation. 2016; 133(24):2459-502. PMC: 4910510. DOI: 10.1161/CIRCULATIONAHA.116.022194. View

13.

Pedrizzetti G, Claus P, Kilner P, Nagel E . Principles of cardiovascular magnetic resonance feature tracking and echocardiographic speckle tracking for informed clinical use. J Cardiovasc Magn Reson. 2016; 18(1):51. PMC: 5000424. DOI: 10.1186/s12968-016-0269-7. View

14.

Liu X, Gao Y, Guo Y, Xia C, Shi R, Jiang L . Cardiac magnetic resonance T1 mapping for evaluating myocardial fibrosis in patients with type 2 diabetes mellitus: correlation with left ventricular longitudinal diastolic dysfunction. Eur Radiol. 2022; 32(11):7647-7656. DOI: 10.1007/s00330-022-08800-9. View

15.

Buss S, Breuninger K, Lehrke S, Voss A, Galuschky C, Lossnitzer D . Assessment of myocardial deformation with cardiac magnetic resonance strain imaging improves risk stratification in patients with dilated cardiomyopathy. Eur Heart J Cardiovasc Imaging. 2014; 16(3):307-15. DOI: 10.1093/ehjci/jeu181. View

16.

Haaf P, Garg P, Messroghli D, Broadbent D, Greenwood J, Plein S . Cardiac T1 Mapping and Extracellular Volume (ECV) in clinical practice: a comprehensive review. J Cardiovasc Magn Reson. 2016; 18(1):89. PMC: 5129251. DOI: 10.1186/s12968-016-0308-4. View

17.

Claus P, Omar A, Pedrizzetti G, Sengupta P, Nagel E . Tissue Tracking Technology for Assessing Cardiac Mechanics: Principles, Normal Values, and Clinical Applications. JACC Cardiovasc Imaging. 2015; 8(12):1444-1460. DOI: 10.1016/j.jcmg.2015.11.001. View

18.

Boudina S, Abel E . Diabetic cardiomyopathy revisited. Circulation. 2007; 115(25):3213-23. DOI: 10.1161/CIRCULATIONAHA.106.679597. View

19.

Levelt E, Mahmod M, Piechnik S, Ariga R, Francis J, Rodgers C . Relationship Between Left Ventricular Structural and Metabolic Remodeling in Type 2 Diabetes. Diabetes. 2015; 65(1):44-52. PMC: 4890658. DOI: 10.2337/db15-0627. View

20.

Schelbert E, Messroghli D . State of the Art: Clinical Applications of Cardiac T1 Mapping. Radiology. 2016; 278(3):658-76. DOI: 10.1148/radiol.2016141802. View