Abstract
Background: To investigate the difference in myocardial extracellular volume fraction (ECV) by cardiac magnetic resonance (CMR) T1 mapping between patients with and without type 2 diabetes (T2D), and the effect of ECV and T2D on cardiovascular (CV) outcomes.Methods: All patients aged > 18 years with known or suspected coronary artery disease who underwent CMR for assessment of myocardial ischemia or myocardial viability at the Department of Cardiology of the Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand from September 2017 to December 2018 were screened for inclusion eligibility. Left ventricular ejection fraction (LVEF), late gadolinium enhancement, and T1 mapping were performed. ECV values were derived from myocardial native T1 and contrast-enhanced T1 values that were obtained using modified Look-Locker inversion recovery at the septum of the mid-cavity short-axis map. Demographic data, clinical characteristics, and CV outcomes were collected by retrospective chart review. Composite CV outcomes included CV death, acute coronary syndrome, heart failure hospitalization, or ventricular tachycardia (VT)/ventricular fibrillation.Results: A total of 739 subjects (mean age: 69.5 ± 14.0 years, 49.3% men) were included. Of those, 188 subjects had T2D (25.4%). ECV was significantly higher in T2D than in non-T2D (30.0 ± 5.9% vs. 28.8 ± 4.7%, p = 0.004). During the mean follow-up duration of 26.2 ± 8.5 months, 43 patients (5.8%) had a clinical composite outcome, as follows: three CV death (0.4%), seven acute coronary syndrome (0.9%), 33 heart failure hospitalization (4.5%), and one VT (0.1%). T2D, low LVEF, and high ECV were all identified as independent predictors of CV events. Patients with T2D and high ECV had the highest risk of CV events.Conclusion: Among patients with known or suspected coronary artery disease, patients with T2D had a higher ECV. T2D and high ECV were both found to be independent risk factors for adverse CV outcomes.
Highlights
Type 2 diabetes mellitus (T2D), which is a common chronic disease, is a well-recognized risk factor for heart failure (HF) independent of age, hypertension (HT), obesity, hypercholesterolemia, and coronary artery disease (CAD) [1]
This study aimed to investigate myocardial extracellular volume fraction (ECV) by cardiac magnetic resonance (CMR) T1 mapping compared between patients with and without T2D among patients with known or suspected CAD who were referred for CMR, and the effect of ECV and T2D on cardiovascular (CV) outcomes, including CV death, acute coronary syndrome (ACS), HF hospitalization, or ventricular tachycardia (VT)/ventricular fibrillation (VF)
There were no significant differences in left ventricular ejection fraction (LVEF) and native T1 between T2D and non-T2D; T2D had a greater proportion of late gadolinium enhancement (LGE) and significantly higher ECV compared to non-T2D
Summary
Type 2 diabetes mellitus (T2D), which is a common chronic disease, is a well-recognized risk factor for heart failure (HF) independent of age, hypertension (HT), obesity, hypercholesterolemia, and coronary artery disease (CAD) [1]. Patients with T2D have worse outcomes once HF has developed [2]. The direct effect of hyperglycemia and insulin resistance on myocardial cellular metabolism may contribute to cardiac dysfunction by alteration of energy-substrate supply and impairment of metabolic-substrate switching under stress conditions. AGEs increase both cardiac stiffening and collagen cross-linking in the myocardial ECM, both of which adversely affect systolic and diastolic cardiac function [3, 4]. To investigate the difference in myocardial extracellular volume fraction (ECV) by cardiac magnetic resonance (CMR) T1 mapping between patients with and without type 2 diabetes (T2D), and the effect of ECV and T2D on cardiovascular (CV) outcomes
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