Abstract
Objectives In a cohort of type 2 diabetic (T2D) patients who underwent baseline cardiac magnetic resonance (CMR) and biomarker testing, during a median follow-up of 6 years, we aimed to determine longitudinal changes in the phenotypic expression of heart disease in diabetes, report clinical outcomes, and compare baseline clinical characteristics and CMR findings of patients who experienced major adverse cardiovascular events (MACE) to those remaining MACE free. Background T2D increases the risk of heart failure (HF) and cardiovascular mortality. The long-term impact of T2D on cardiac phenotype in the absence of cardiovascular disease and other clinical events is unknown. Methods Patients with T2D (n = 100) with no history of cardiovascular disease or hypertension were recruited at baseline. Biventricular volumes, function, and myocardial extracellular volume fraction (ECV) were assessed by CMR, and blood biomarkers were taken. Follow-up CMR was repeated in those without interim clinical events after 6 years. Results Follow-up was successful in 83 participants. Of those, 29 experienced cardiovascular/clinical events (36%). Of the remaining 59, 32 patients who experienced no events received follow-up CMR. In this cohort, despite no significant changes in blood pressure, weight, or glycated hemoglobin, significant reductions in biventricular end-diastolic volumes and ejection fractions occurred over time. The mean ECV was unchanged. Baseline plasma high-sensitivity cardiac troponin T (hs-cTnT) was significantly associated with a change in left ventricular (LV) ejection fraction. Patients who experienced MACE had higher LV mass and greater LV concentricity than those who remained event free. Conclusions T2D results in reductions in biventricular size and systolic function over time even in the absence of cardiovascular/clinical events.
Highlights
Cardiovascular disease represents the primary cause of death in type 2 diabetic patients (T2D) [1]
Of the hundred participants with T2D recruited at baseline (82 men, mean age 61 ± 11 years, median diabetic duration 4.1 years (IQR: 1.4–7 years), 17 participants were uncontactable (Figure 2). e healthcare records of the remaining 83 participants revealed that 5 participants (6%) had died during the follow-up period (one due to acute coronary syndrome (ACS)), 8 participants (9.6%) had survived an ACS, 3 participants (3.8%) had a cerebrovascular accident, 6 participants (7.7%) developed a malignancy, 1 participant (1.3%) had a permanent pacemaker implanted for a high-grade atrioventricular block, and 1 participant (1.3%) developed significant renal dysfunction (Figure 2). ese participants were not invited back for a follow-up Cardiac magnetic resonance imaging (CMR) scan
In a cohort of ethnically diverse, asymptomatic patients with T2D with no history of prior cardiovascular disease, this study has shown for the first time that T2D is associated with clinically relevant adverse changes in biventricular function at follow-up after 6 years even in the absence of cardiovascular events, cardiac ischemia, or other predisposing factors such as hypertension. e present data have shown that baseline glucose control seems to have no effect, plasma high-sensitivity cardiac troponin T (hs-cTnT) does predict the magnitude of the subsequent change in left ventricular ejection fraction (LVEF)
Summary
Cardiovascular disease represents the primary cause of death in type 2 diabetic patients (T2D) [1]. E early detection of adverse subclinical myocardial structural and functional alterations associated with progressive myocardial dysfunction might offer the opportunity of early initiation of disease-modifying pharmacological therapies prior to the onset of overt HF [7]. To our knowledge no CMR study to date has examined longitudinal changes in biventricular structure and function in patients with T2D with no prior cardiovascular disease. In this longitudinal observational study, we tested the hypothesis that T2D would be associated with a progressive decline in biventricular systolic function even in a cohort of diabetic patients with no prior cardiovascular disease or interim major adverse cardiovascular events (MACE) during the follow-up period. We sought to report clinical outcomes and compare demographic, clinical, and biochemical variables, and CMR and plasma biomarkers measured at baseline between those patients who experienced MACE and those who remained free of MACE during the follow-up period
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