Left ventricular subclinical myocardial dysfunction in uncomplicated type 2 diabetes mellitus is associated with impaired myocardial perfusion: a contrast-enhanced cardiovascular magnetic resonance study

Abstract

BackgroundEarly detection of subclinical myocardial dysfunction in patients with diabetes mellitus (DM) is essential for recommending therapeutic interventions that can prevent or reverse heart failure, thereby improving the prognosis in such patients. This study aims to quantitatively evaluate left ventricular (LV) myocardial deformation and perfusion using cardiovascular magnetic resonance (CMR) imaging in patients with type 2 diabetes mellitus (T2DM), and to investigate the association between LV subclinical myocardial dysfunction and coronary microvascular perfusion.MethodsWe recruited 71 T2DM patients and 30 healthy individuals as controls who underwent CMR examination. The T2DM patients were subdivided into two groups, namely the newly diagnosed DM group (n = 31, patients with diabetes for ≤ 5 years) and longer-term DM group (n = 40, patients with diabetes > 5 years). LV deformation parameters, including global peak strain (PS), peak systolic strain rate, and peak diastolic strain rate (PSDR), and myocardial perfusion parameters such as upslope, time to maximum signal intensity (TTM), and max signal intensity (Max SI, were measured and compared among the three groups. Pearson’s correlation was used to evaluate the correlation between LV deformation and perfusion parameters.ResultsPooled data from T2DM patients showed a decrease in global longitudinal, circumferential, and radial PDSR compared to healthy individuals, apart from lower upslope. In addition, increased TTM and reduced Max SI were found in the longer-term diabetics compared to the normal subjects (p < 0.017 for all). Multivariable linear regression analysis showed that T2DM was independently associated with statistically significant CMR parameters, except for TTM (β = 0.137, p = 0.195). Further, longitudinal PDSR was significantly associated with upslope (r = − 0.346, p = 0.003) and TTM (r = 0.515, p < 0.001).ConclusionsOur results imply that a contrast-enhanced 3.0T CMR can detect subclinical myocardial dysfunction and impaired myocardial microvascular perfusion in the early stages of T2DM, and that the myocardial dysfunction is associated with impaired coronary microvascular perfusion.Electronic supplementary materialThe online version of this article (10.1186/s12933-018-0782-0) contains supplementary material, which is available to authorized users.

Early detection of left atrial and bi-ventricular myocardial strain abnormalities by MRI feature tracking in normotensive or hypertensive T2DM patients with preserved LV function

“…In our study, CMR-derived LV strains were similar among the three groups regardless of the presence of coexisting hypertension. We did not observe that a significantly decreased GLS in T2DM patients compared with normal subjects [30]. The above difference may lie in the duration of diabetes in the study populations.…”

“…The above difference may lie in the duration of diabetes in the study populations. Specifically, the mean duration of diabetes in the longerterm T2DM group was approximately 11 years in Liu's study [30], whereas the duration in our study was relatively short at only approximately 8 years. In this study, we also found that the LA strain changed significantly, indicating that LA deformation-related impairment could appear even earlier than the LV strain in the early stages of DCM, a finding that is consistent with Cameli's study [31].…”

The Additive Effects of Type 2 Diabetes Mellitus on Left Ventricular Deformation and Myocardial Perfusion in Essential Hypertension: a 3.0T Cardiac Magnetic Resonance Study

“…The main ndings of this study are as follows: 1 Similar to most progressive myocardial diseases, subendocardial bers are more vulnerable to being affected; thus, longitudinal contractile function representing as GLPS may be impaired earlier and more severely [8] , as shown in previous studies with hypertension [17,18] and T2DM [13,19] , as well as in our patients. In hypertension, there is insulin resistance and activation of the sympathetic nervous system and renin-angiotensin-aldosterone system, which may result in diffuse myocardial brosis [12] .…”

“…The increased resting myocardial perfusion in hypertension may re ect an adaptive mechanism, adapting to the increased oxygen demand for the heart to work under increased afterload [22,25] . In T2DM, increased resting myocardial perfusion has been exhibited in some previous studies [26][27][28] , while others have reported decreased resting perfusion [19,29] . This discrepancy may be due to different study populations, investigation modalities, and relatively modest sample sizes.…”

Independence of coronary artery disease to subclinical left ventricular dysfunction

“…Although there is a strong association between CAC and incident HF, only partly mitigated after adjustment for cardiovascular risk factors, 7,8 it seems likely that this reflects the contribution of overt CAD to HF. Previous studies suggesting a link between CAC and LV dysfunction were in patients with very high burdens of CAC (≥400), 9 greater severity of LV dysfunction measured by ejection fraction, 10,11 or high baseline risk, such as those with suspected CAD or known diabetes 12,13 . The role of CAD in the development of SBHF is unclear in the setting of early disease.…”