Abstract
BackgroundType 2 diabetes mellitus (T2DM) is a major risk factor for coronary artery disease and myocardial infarction (MI). The interaction of diabetic cardiomyopathy and MI scars on myocardial deformation in T2DM patients is unclear. Therefore, we aimed to evaluate myocardial deformation using cardiac magnetic resonance (CMR) in T2DM patients with previous MI and investigated the influence of myocardial scar on left ventricular (LV) deformation.MethodsOverall, 202 T2DM patients, including 46 with MI (T2DM(MI+)) and 156 without MI (T2DM(MI−)), and 59 normal controls who underwent CMR scans were included. Myocardial scars were assessed by late gadolinium enhancement. LV function and deformation, including LV global function index, LV global peak strain (PS), peak systolic strain rate (PSSR), and peak diastolic strain rate (PDSR), were compared among these groups. Correlation and multivariate linear regression analyses were used to investigate the relationship between myocardial scars and LV deformation.ResultsDecreases were observed in LV function and LV global PS, PSSR, and PDSR in the T2DM(MI+) group compared with those of the other groups. Reduced LV deformation (p < 0.017) was observed in the T2DM(MI+) group with anterior wall infarction. The increased total LV infarct extent and infarct mass of LV were related to decreased LV global PS (radial, circumferential, and longitudinal directions; p < 0.01) and LV global PSSR (radial and circumferential directions, p < 0.02). Multivariate analysis demonstrated that NYHA functional class and total LV infarct extent were independently associated with LV global radial PS (β = − 0.400 and β = − 0.446, respectively, all p < 0.01; model R2 = 0.37) and circumferential PS (β = 0.339 and β = 0.530, respectively, all p < 0.01; model R2 = 0.41), LV anterior wall infarction was independently associated with LV global longitudinal PS (β = 0.398, p = 0.006).ConclusionsThe myocardial scarring size in T2DM patients after MI is negatively correlated with LV global PS and PSSR, particularly in the circumferential direction. Additionally, different MI regions have different effects on the reduction of LV deformation, and relevant clinical evaluations should be strengthened.
Highlights
Diabetic cardiomyopathy (DCM) is defined as myocardial dysfunction independent of coronary artery disease and hypertension that can lead to heart failure [1, 2]
Thirty-four patients were identified with culprit vessels, of which 14 (30.43%) were the left anterior descending coronary artery (LAD), 6 (13.0%) were the left circumflex coronary artery (LCx), and 14 (30.43%) were the right coronary artery (RCA)
We found that Type 2 diabetes mellitus (T2DM) (MI+) patients had reduced left ventricular (LV) global peak diastolic strain rate (PDSR) in the three directions compared with T2DM (MI−) patients, but no correlation was observed between LV global PDSR and the extent of myocardial scarring
Summary
Diabetic cardiomyopathy (DCM) is defined as myocardial dysfunction independent of coronary artery disease and hypertension that can lead to heart failure [1, 2]. Diastolic dysfunction is one of the important indicators of early left ventricular (LV) dysfunction before reduced LV ejection fraction in DCM, and the impaired global longitudinal strain was associated with cardiovascular events in type 2 diabetes mellitus (T2DM) patients [3,4,5]. Previous studies have pointed out that the MI size and transmural type in MI patients have an important effect on prognosis and survival. Few studies have investigated the effects of myocardial scar on myocardial deformation after MI in T2DM patients with DCM. Type 2 diabetes mellitus (T2DM) is a major risk factor for coronary artery disease and myocardial infarc‐ tion (MI). We aimed to evaluate myocardial deformation using cardiac magnetic resonance (CMR) in T2DM patients with previous MI and investigated the influence of myocardial scar on left ventricular (LV) deformation
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