Left Ventricular Diastolic Function in Type 2 Diabetes Mellitus and the Association With Coronary Artery Calcium Score: A Cardiac MRI Study

Abstract

C a r d io p u l m o n a r y I m ag i ng • O r ig i n a l R e s e a rc hThis article is available for credit. This research was financially supported by Project "DoIT," which is cofinanced by the European Community Fund FEDER through COMPETE. rosis [10], which can be detected noninvasively by MDCT.Coronary artery disease is commonly cited as a mechanism underlying diastolic dysfunction [11]. Many of the same factors that contribute to atherosclerosis may also produce LV diastolic dysfunction by either direct mechanisms (e.g., hypertension and age-related vascular stiffening) or secondarily via coronary artery disease progression and resulting changes in myocardial compliance [11].There are limited and controversial published data on the relationship of CAC to LV diastolic function. Edvardsen et al. [12] reported that coronary atherosclerosis is associated with depressed regional LV systolic and diastolic wall strain measured by MRI tagging. Colletti et al. [13] found that a CAC score greater than 100 predicts an increased likelihood of clinically unsuspected LV regional wall motion abnormalities, which are C ardiovascular disease is the most frequent cause of death and disability in patients with type 2 diabetes mellitus (DM2). DM2 is responsible for diverse cardiovascular complications such as increased coronary atherosclerosis and left ventricular (LV) dysfunction. LV diastolic dysfunction is highly prevalent in DM2 [1,2], representing the earliest preclinical manifestation of LV dysfunction in patients with this condition [3][4][5][6].Over the past decade, cardiac MRI has been widely accepted as the reference standard for the assessment of cardiac structure and function because of its high spatial and temporal resolution, excellent image quality, and lack of geometric assumptions [7]. Cardiac MRI offers a variety of alternative approaches for evaluating diastolic function [8,9].The presence of coronary artery calcium (CAC) is indicative of coronary atheroscle-OBJECTIVE. The purpose of this study was to compare cardiac MRI-derived parameters of left ventricular (LV) diastolic function between uncomplicated type 2 diabetes mellitus (DM2) and normoglycemic control subjects and to evaluate whether these parameters of LV diastolic function are related to coronary atherosclerosis. SUBJECTS AND METHODS.We prospectively studied 41 subjects with DM2 and 21 normoglycemic control subjects (30 women and 32 men; mean age, 57.2 ± 7.1 [SD] years) with no evidence of overt cardiovascular disease. We used cardiac MRI to measure LV volumes, LV peak filling rate (PFR), and transmitral flow and CT to determine coronary artery calcium scores.RESULTS. Absolute values of the peak filling rate (PFR) were significantly lower in DM2 patients than in control subjects (mean ± SD, 293.2 ± 51.7 vs 375.7 ± 102.8 mL/s, respectively; p < 0.001). Mitral peak E velocities (mean ± SD, 42.8 ± 10.7 vs 48.8 ± 10.4 cm/s; p = 0.040) and peak E velocity-to-peak A velocity ratios (0.88 ± 0.3 vs 1.1 ± 0.3; p = 0.002) were also lower in DM2 patients com...

Volume-time curve of cardiac magnetic resonance assessed left ventricular dysfunction in coronary artery disease patients with type 2 diabetes mellitus

“…To define the volume-time curve index of CMR, the PER indicates the peak rate of left ventricular ejection, which is evaluated from the maximal LV ejection rate defined by the maximal change in the LV volume between sequential temporal phases (△volume/△phase). The PFR indicates the maximal LV filling rate defined by maximal change in LV volume between sequential temporal phases (△volume/△phase) [14]. PER/EDV represents the PER when normalized to EDV, and PFR/EDV represents the PFR when normalized to EDV.…”

“…DM2 has an adverse effect on coronary microvascular dysfunction and left ventricular diastolic function. Previous research has found that DM2 patients had a lower PFR than normal individuals, indicating the presence of impaired myocardial relaxation and increased myocardial stiffness; consequently, the abnormal LV filling in DM2 patients is closely associated with abnormal myocardial perfusion [14]. In the study conducted by Zeidan et al, volume-time curves of CAD patients revealed significantly PFR [21].…”

“…Meanwhile, the diabetes mellitus is a major risk factor for the development of LV dysfunction even in the absence of symptom of, and the T2DM have an evidence of systolic ventricular dysfunction [13]. In addition, Graça et cal found that patients with DM and coronary atherosclerosis show a more impaired LV diastolic function than patients without coronary atherosclerosis by only using LV PFR normalized to stroke volume of CMR [14]. However, to the best of our knowledge, detailed global LV function assessed by in CAD patients with DM2 compared with CAD without DM2 is currently insufficient and certain LV diastolic and systolic function parameters that are derived from the volume-time curve are still not comprehensive.…”

Evaluation of diastolic function in patients with normal perfusion and type 2 diabetes mellitus with gated single-photon emission computed tomography

“…[9] found that the PFR values in patients with Type 2 DM were significantly lower than those in the control group. In our study with G-SPECT, the PFR in patients with DM was also significantly lower than that in patients without DM.…”

Benefits of 1-Year Lifestyle Modification Program on Exercise Capacity and Diastolic Function Among Coronary Artery Disease Men With and Without Type 2 Diabetes

“…11 Using PFR normalized to LV stroke volume, Graca et al have reported LVDD in patients with T2DM and CAD compared with those without CAD. 12 Despite evidence of an abnormal LV diastolic filling profile associated with CAD, less is known about the influence of a lifestyle modification program on LV diastolic filling and diastolic function in patients with CAD and with varying levels of glucose tolerance.…”