Abstract
BackgroundCardiac magnetic resonance (CMR) T1 mapping and tissue-tracking strain analysis are useful quantitative techniques that can characterize myocardial tissue and mechanical alterations, respectively, in patients with early diabetic cardiomyopathy. The purpose of this study was to assess the left ventricular myocardial T1 value, extracellular volume fraction (ECV), and systolic strain in asymptomatic patients with type 2 diabetes mellitus (T2DM) and their underlying relationships with clinical parameters.MethodsWe recruited 50 T2DM patients (mean age: 55 ± 7 years; 28 males) and 32 sex-, age-and BMI-matched healthy volunteers to undergo contrast-enhanced CMR examinations. The myocardial native T1, post-contrast T1 and ECV values of the left ventricle were measured from T1 and ECV maps acquired using the modified Look-Locker inversion recovery technique. The left ventricular global systolic strain and the strain rates were evaluated using routine cine images and tissue-tracking analysis software. The baseline clinical and biochemical indices were collected before the CMR examination.ResultsThe myocardial ECV and native T1 values were significantly higher in the diabetic patients than in the controls. (ECV: 27.4 ± 2.5% vs. 24.6 ± 2.2%, p < 0.001; native T1: 1026.9 ± 30.0 ms vs. 1011.8 ± 26.0 ms, p = 0.022). However, the left ventricular global systolic strain, strain rate, volume, myocardial mass, ejection fraction, and left atrial volume were similar between the diabetic patients and the healthy controls. In the diabetic patients, the native T1 values were independently correlated with the hemoglobin A1c levels (standardized β = 0.368, p = 0.008). The ECVs were independently associated with the hemoglobin A1c levels (standardized β = 0.389, p = 0.002), angiotensin-converting enzyme inhibitor (ACEI) treatment (standardized β = − 0.271, p = 0.025) and HCT values (standardized β = − 0.397, p = 0.001).ConclusionsType 2 diabetes mellitus patients with normal myocardial systolic strain exhibit increased native T1 values and ECVs indicative of myocardial extracellular interstitial expansion, which might be related to poor glycemic control. The amelioration of myocardial interstitial matrix expansion might be associated with ACEI treatment. A valid assessment of the association of glucose control and ACEI treatment with myocardial fibrosis requires notably larger trials.
Highlights
Cardiac magnetic resonance (CMR) T1 mapping and tissue-tracking strain analysis are useful quantitative techniques that can characterize myocardial tissue and mechanical alterations, respectively, in patients with early diabetic cardiomyopathy
(implanted metallic objects, such as a cardiac pacemaker, metal valve and insulin pump, or an allergy to contrast media), diabetes with poorly controlled hypertension and left ventricular hypertrophy, and the presence of abnormal cardiac dimensions, global or regional left ventricular wall motion abnormalities, valvular stenosis or regurgitation or myocardial late gadolinium enhancement (LGE) during the MRI examination
No significant differences were observed in the left ventricular end-diastolic volume (LVEDV) index (61.0 ± 12.6 vs. 63.7 ± 11.2 mL/m2; p = 0.336), left ventricular end-systolic volume (LVESV) index (28.3 ± 6.7 vs. 27.5 ± 6.4 mL/m2; p = 0.611), left ventricular ejection fraction (LVEF) (55.0 ± 6.2 vs. 57.2 ± 4.6%; p = 0.077), left ventricular mass (LVM) index (53.9 ± 8.7 vs. 55.9 ± 6.6 g/m2; p = 0.269) and left atrial volume (LAV) index (38.1 ± 10.0 vs. 36.9 ± 11.0 mL/m2; p = 0.585) between the patients and the controls
Summary
Cardiac magnetic resonance (CMR) T1 mapping and tissue-tracking strain analysis are useful quantitative techniques that can characterize myocardial tissue and mechanical alterations, respectively, in patients with early diabetic cardiomyopathy. The purpose of this study was to assess the left ventricular myocardial T1 value, extracellular volume fraction (ECV), and systolic strain in asymptomatic patients with type 2 diabetes mellitus (T2DM) and their underlying relationships with clinical parameters. Late gadolinium enhancement imaging with cardiovascular magnetic resonance (CMR) can accurately detect regional myocardial infarction or fibrosis [7]. This technology cannot identify diffuse myocardial fibrosis due to the absence of signal intensity differences between fibrosis and the normal myocardium [8]. Some studies revealed that diabetic patients had lower post-contrast myocardial T1 values and greater ECVs, suggestive of extracellular interstitial expansion compared with healthy subjects, the left ventricular volumes and ejection fractions were normal [12, 13]. Whether abnormal T1 and ECV values exist in asymptomatic preclinical diabetic cardiomyopathy patients and the associations of these values with cardiac functions and the involved clinical indices remain unclear
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