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Garefa C, Sager DF, Heiniger PS, Markendorf S, Albertini T, Jurisic S, Gajic M, Gebhard C, Benz DC, Pazhenkottil AP, Giannopoulos AA, Kaufmann PA, Slomka PJ, Buechel RR. Duration of adenosine-induced myocardial hyperaemia: insights from quantitative 13N-ammonia positron emission tomography myocardial perfusion imaging. Eur Heart J Cardiovasc Imaging 2024; 25:1367-1373. [PMID: 38584491 PMCID: PMC11441031 DOI: 10.1093/ehjci/jeae096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 03/25/2024] [Accepted: 04/03/2024] [Indexed: 04/09/2024] Open
Abstract
AIMS This study aimed to assess the impact of adenosine on quantitative myocardial blood flow (MBF) in a rapid stress-rest protocol compared with a rest-stress protocol using 13N-ammonia positron emission tomography (PET) myocardial perfusion imaging (MPI) and to gain insights into the time dependency of such effects. METHODS AND RESULTS Quantitative MBF at rest (rMBF) and during adenosine-induced stress (sMBF) and myocardial flow reserve (MFR) were obtained from 331 retrospectively identified patients who underwent 13N-ammonia PET MPI for suspected chronic coronary syndrome and who all exhibited no perfusion defects. Of these, 146 (44.1%) underwent a rapid stress-rest protocol with a time interval (Δtstress-rest) of 20 ± 4 min between adenosine infusion offset and rest imaging, as per clinical routine. The remaining 185 (55.9%) patients underwent a rest-stress protocol and served as the reference. Groups did not differ regarding demographics, risk factors, medication, left ventricular function, and calcium scores. rMBF was significantly higher in the stress-rest vs. the rest-stress group [0.80 (interquartile range 0.66-1.00) vs. 0.70 (0.58-0.83) mL·min-1·g-1, P < 0.001], and, as sMBF was identical between groups [2.52 (2.20-2.96) vs. 2.50 (1.96-3.11), P = 0.347], MFR was significantly lower in the stress-rest group [3.07 (2.43-3.88) vs. 3.50 (2.63-4.10), P = 0.007]. There was a weak correlation between Δtstress-rest and rMBF (r = -0.259, P = 0.002) and between Δtstress-rest and MFR (r = 0.163, P = 0.049), and the proportion of patients with abnormally high rMBF was significantly decreasing with increasing Δtstress-rest. CONCLUSION Intravenously applied adenosine induces a long-lasting hyperaemic effect on the myocardium. Consequently, rapid stress-rest protocols could lead to an overestimation of rMBF and an underestimation of MFR.
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Affiliation(s)
- Chrysoula Garefa
- Department of Nuclear Medicine, Cardiac Imaging, University and University Hospital Zurich, NUK A 12, Ramistrasse 100, Zurich 8091, Switzerland
| | - Dominik F Sager
- Department of Nuclear Medicine, Cardiac Imaging, University and University Hospital Zurich, NUK A 12, Ramistrasse 100, Zurich 8091, Switzerland
| | - Pascal S Heiniger
- Department of Nuclear Medicine, Cardiac Imaging, University and University Hospital Zurich, NUK A 12, Ramistrasse 100, Zurich 8091, Switzerland
| | - Susanne Markendorf
- Department of Nuclear Medicine, Cardiac Imaging, University and University Hospital Zurich, NUK A 12, Ramistrasse 100, Zurich 8091, Switzerland
| | - Tobia Albertini
- Department of Nuclear Medicine, Cardiac Imaging, University and University Hospital Zurich, NUK A 12, Ramistrasse 100, Zurich 8091, Switzerland
| | - Stjepan Jurisic
- Department of Nuclear Medicine, Cardiac Imaging, University and University Hospital Zurich, NUK A 12, Ramistrasse 100, Zurich 8091, Switzerland
| | - Marko Gajic
- Department of Nuclear Medicine, Cardiac Imaging, University and University Hospital Zurich, NUK A 12, Ramistrasse 100, Zurich 8091, Switzerland
| | - Catherine Gebhard
- Department of Nuclear Medicine, Cardiac Imaging, University and University Hospital Zurich, NUK A 12, Ramistrasse 100, Zurich 8091, Switzerland
| | - Dominik C Benz
- Department of Nuclear Medicine, Cardiac Imaging, University and University Hospital Zurich, NUK A 12, Ramistrasse 100, Zurich 8091, Switzerland
| | - Aju P Pazhenkottil
- Department of Nuclear Medicine, Cardiac Imaging, University and University Hospital Zurich, NUK A 12, Ramistrasse 100, Zurich 8091, Switzerland
| | - Andreas A Giannopoulos
- Department of Nuclear Medicine, Cardiac Imaging, University and University Hospital Zurich, NUK A 12, Ramistrasse 100, Zurich 8091, Switzerland
| | - Philipp A Kaufmann
- Department of Nuclear Medicine, Cardiac Imaging, University and University Hospital Zurich, NUK A 12, Ramistrasse 100, Zurich 8091, Switzerland
| | - Piotr J Slomka
- Division of Artificial Intelligence in Medicine, Imaging, and Biomedical Sciences, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Ronny R Buechel
- Department of Nuclear Medicine, Cardiac Imaging, University and University Hospital Zurich, NUK A 12, Ramistrasse 100, Zurich 8091, Switzerland
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Li X, Kang S, Lu Z, Liu Y, Danzengquyang, Xiao H, Ma W, Pan J. Assessment of myocardial microvascular dysfunction in patients with different stages of diabetes mellitus: An adenosine stress perfusion cardiac magnetic resonance study. Eur J Radiol 2024; 178:111600. [PMID: 39029239 DOI: 10.1016/j.ejrad.2024.111600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Revised: 06/25/2024] [Accepted: 07/01/2024] [Indexed: 07/21/2024]
Abstract
PURPOSE To examine myocardial perfusion and T1 mapping indicesin individuals with type 2 diabetes mellitus (T2DM) at various stages of glycemic control and whether uncontrolled glycemic levels would worsen myocardial microvascular function. METHOD Cardiac magnetic resonance examinations were performed on 114 T2DM patients without obstructive coronary artery disease and 55 matched controls. Participants were further divided into four subgroups: Q1 (control); Q2 (prediabetes); Q3 (controlled T2DM) and Q4 (uncontrolled T2DM). The correlation between glycosylated hemoglobin (HbA1c) levels and myocardial perfusion parameters was evaluated. RESULTS Global myocardial perfusion reserve index (MPRI) was significantly reduced in the Q3 and Q4 subgroups compared to the Q1 or Q2 subgroup (all P<0.001). Compared with the Q1 subgroup, global stress T1 reactivity (stress ΔT1) was significantly reduced in the Q3 and Q4 subgroups (P=0.004 and < 0.001, respectively), but elevated in the Q2 subgroup (P=0.018). Global extracellular volume (ECV) was considerably higher in the Q2 subgroup and gradually rose in the Q3 and Q4 subgroups compared to the Q1 subgroup (P=0.011, 0.001, and 0.007, respectively). HbA1c levels correlated negatively with global MPRI and stress ΔT1, but positively with global ECV (β = -1.993, P<0.001; β = -0.180, P<0.001; and β = 0.127, P<0.001, respectively). CONCLUSIONS Global stress ΔT1 reduced in T2DM patients but rose in prediabetes patients. Compared to MPRI, the ECV parameter can indicate diabetes-induced coronary microvascular dysfunction earlier and persists throughout the disorder. Myocardial perfusion and T1 mapping at stress can be used to detect early signs of microvascular dysfunction and subclinical risk factors in patients with T2DM.
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Affiliation(s)
- Xinni Li
- Department of Cardiology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Jiao Tong University, Shanghai 200233, China.
| | - Sang Kang
- Department of Cardiology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Jiao Tong University, Shanghai 200233, China.
| | - Zhigang Lu
- Department of Cardiology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Jiao Tong University, Shanghai 200233, China.
| | - Yuting Liu
- Department of Cardiology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Jiao Tong University, Shanghai 200233, China.
| | - Danzengquyang
- Department of Cardiology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Jiao Tong University, Shanghai 200233, China.
| | - Huoyuan Xiao
- Department of Cardiology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Jiao Tong University, Shanghai 200233, China.
| | - Wenkun Ma
- Department of Cardiology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Jiao Tong University, Shanghai 200233, China.
| | - Jingwei Pan
- Department of Cardiology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Jiao Tong University, Shanghai 200233, China.
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Devesa A, Fuster V, García-Lunar I, Oliva B, García-Alvarez A, Moreno-Arciniegas A, Vazirani R, Pérez-Herreras C, Marina P, Bueno H, Fernández-Friera L, Fernández-Ortiz A, Sanchez-Gonzalez J, Ibanez B. Coronary Microvascular Function in Asymptomatic Middle-Aged Individuals With Cardiometabolic Risk Factors. JACC Cardiovasc Imaging 2024:S1936-878X(24)00342-5. [PMID: 39269413 DOI: 10.1016/j.jcmg.2024.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Revised: 07/01/2024] [Accepted: 08/01/2024] [Indexed: 09/15/2024]
Abstract
BACKGROUND In patients with ischemic heart disease, coronary microvascular dysfunction is associated with cardiovascular risk factors and poor prognosis; however, data from healthy individuals are scarce. OBJECTIVES The purpose of this study was to assess the impact of cardiovascular risk factors and subclinical atherosclerosis on coronary microvascular function in middle-aged asymptomatic individuals. METHODS Myocardial perfusion was measured at rest and under stress using cardiac magnetic resonance in 453 individuals and used to generate myocardial blood flow (MBF) maps and calculate myocardial perfusion reserve (MPR). Subclinical atherosclerosis was assessed using 3-dimensional vascular ultrasound of the carotid and femoral arteries and coronary artery calcium scoring at baseline and at 3-year follow-up. RESULTS Median participant age was 52.6 years (range: 48.9-55.8 years), and 84.5% were male. After adjusting for age and sex, rest MBF was directly associated with the number of the metabolic syndrome components present (elevated waist circumference, systolic and diastolic blood pressure, fasting glucose, and triglycerides and low high-density lipoprotein cholesterol), insulin resistance (homeostatic model assessment for insulin resistance), and presence of diabetes. MPR was reduced in the presence of several metabolic syndrome components, elevated homeostatic model assessment for insulin resistance, and diabetes. Stress MBF was inversely associated with coronary artery calcium presence and with global plaque burden. Higher stress MBF and MPR were associated with less atherosclerosis progression (increase in plaque volume) at 3 years. CONCLUSIONS In asymptomatic middle-aged individuals free of known cardiovascular disease, the presence of cardiometabolic risk factors and systemic (poly-vascular) subclinical atherosclerosis are associated with impaired coronary microvascular function. Better coronary microvascular function reduces atherosclerosis progression at follow-up. (Progression of Early Subclinical Atherosclerosis [PESA]; NCT01410318).
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Affiliation(s)
- Ana Devesa
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, New York, USA; BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Valentin Fuster
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
| | - Inés García-Lunar
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; University Hospital La Moraleja, Madrid, Spain; CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Belén Oliva
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
| | - Ana García-Alvarez
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Cardiology Department, Hospital Clinic-IDIBAPS, Barcelona, Spain
| | | | - Ravi Vazirani
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Hospital Clínico San Carlos, Universidad Complutense, IdISSC, Madrid, Spain
| | | | | | - Héctor Bueno
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain; Cardiology Department, Hospital Universitario 12 de Octubre, and i+12 Research Institute, Madrid, Spain
| | - Leticia Fernández-Friera
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Hospital Universitario HM Montepríncipe-CIEC, Madrid, Spain
| | - Antonio Fernández-Ortiz
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain; Hospital Clínico San Carlos, Universidad Complutense, IdISSC, Madrid, Spain
| | | | - Borja Ibanez
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain; Cardiology Department, IIS Fundación Jiménez Díaz University Hospital, Madrid, Spain.
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Li XN, Liu YT, Kang S, Qu Yang DZ, Xiao HY, Ma WK, Shen CX, Pan JW. Interdependence between myocardial deformation and perfusion in patients with T2DM and HFpEF: a feature-tracking and stress perfusion CMR study. Cardiovasc Diabetol 2024; 23:303. [PMID: 39152461 PMCID: PMC11330131 DOI: 10.1186/s12933-024-02380-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Accepted: 07/29/2024] [Indexed: 08/19/2024] Open
Abstract
BACKGROUND Patients with diabetes have an increased risk of developing heart failure with preserved ejection fraction (HFpEF). This study aimed to compare indices of myocardial deformation and perfusion between patients with type 2 diabetes mellitus (T2DM) with and without HFpEF and to investigate the relationship between myocardial strain and perfusion reserve. METHODS This study included 156 patients with T2DM without obstructive coronary artery disease (CAD) and 50 healthy volunteers who underwent cardiac magnetic resonance (CMR) examination at our center. Patients with T2DM were subdivided into the T2DM-HFpEF (n = 74) and the T2DM-non-HFpEF (n = 82) groups. The parameters of left ventricular (LV) and left atrial (LA) strain as well as stress myocardial perfusion were compared. The correlation between myocardial deformation and perfusion parameters was also assessed. Mediation analyses were used to evaluate the direct and indirect effects of T2DM on LA strain. RESULTS Patients with T2DM and HFpEF had reduced LV radial peak systolic strain rate (PSSR), LV circumferential peak diastolic strain rate (PDSR), LA reservoir strain, global myocardial perfusion reserve index (MPRI), and increased LA booster strain compared to patients with T2DM without HFpEF (all P < 0.05). Furthermore, LV longitudinal PSSR, LA reservoir, and LA conduit strain were notably impaired in patients with T2DM without HFpEF compared to controls (all P < 0.05), but LV torsion, LV radial PSSR, and LA booster strain compensated for these alterations (all P < 0.05). Multivariate linear regression analysis demonstrated that LA reservoir and LA booster strain were independently associated with global MPRI (β = 0.259, P < 0.001; β = - 0.326, P < 0.001, respectively). Further, the difference in LA reservoir and LA booster strain between patients with T2DM with and without HFpEF was totally mediated by global MPRI. Global stress PI, LA booster, global rest PI, and global MPRI showed high accuracy in diagnosing HFpEF among patients with T2DM (areas under the curve [AUC]: 0.803, 0.790, 0.740, 0.740, respectively). CONCLUSIONS Patients with T2DM and HFpEF exhibited significant LV systolic and diastolic deformation, decreased LA reservoir strain, severe impairment of myocardial perfusion, and elevated LA booster strain that is a compensatory response in HFpEF. Global MPRI was identified as an independent influencing factor on LA reservoir and LA booster strain. The difference in LA reservoir and LA booster strain between patients with T2DM with and without HFpEF was totally mediated by global MPRI, suggesting a possible mechanistic link between microcirculation impairment and cardiac dysfunction in diabetes. Myocardial perfusion and LA strain may prove valuable for diagnosing and managing HFpEF in the future.
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Affiliation(s)
- Xin-Ni Li
- Department of Cardiology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, China
| | - Yu-Ting Liu
- Department of Cardiology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, China
| | - Sang Kang
- Department of Cardiology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, China
| | - Dan Zeng Qu Yang
- Department of Cardiology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, China
| | - Huo-Yuan Xiao
- Department of Cardiology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, China
| | - Wen-Kun Ma
- Department of Cardiology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, China
| | - Cheng-Xing Shen
- Department of Cardiology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, China.
| | - Jing-Wei Pan
- Department of Cardiology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, China.
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Sharrack N, Brown LAE, Farley J, Wahab A, Jex N, Thirunavukarasu S, Chowdhary A, Gorecka M, Javed W, Xue H, Levelt E, Dall'Armellina E, Kellman P, Garg P, Greenwood JP, Plein S, Swoboda PP. Occult coronary microvascular dysfunction and ischemic heart disease in patients with diabetes and heart failure. J Cardiovasc Magn Reson 2024; 26:101073. [PMID: 39096970 PMCID: PMC11417243 DOI: 10.1016/j.jocmr.2024.101073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 07/03/2024] [Accepted: 07/26/2024] [Indexed: 08/05/2024] Open
Abstract
BACKGROUND Patients with diabetes mellitus (DM) and heart failure (HF) have worse outcomes than normoglycemic HF patients. Cardiovascular magnetic resonance (CMR) can identify ischemic heart disease (IHD) and quantify coronary microvascular dysfunction (CMD) using myocardial perfusion reserve (MPR). We aimed to quantify the extent of silent IHD and CMD in patients with DM presenting with HF. METHODS Prospectively recruited outpatients undergoing assessment into the etiology of HF underwent in-line quantitative perfusion CMR for calculation of stress and rest myocardial blood flow (MBF) and MPR. Exclusions included angina or history of IHD. Patients were followed up (median 3.0 years) for major adverse cardiovascular events (MACE). RESULTS Final analysis included 343 patients (176 normoglycemic, 84 with pre-diabetes, and 83 with DM). Prevalence of silent IHD was highest in DM 31% ( 26/83), then pre-diabetes 20% (17/84) then normoglycemia 17%, ( 30/176). Stress MBF was lowest in DM (1.53 ± 0.52), then pre-diabetes (1.59 ± 0.54) then normoglycemia (1.83 ± 0.62). MPR was lowest in DM (2.37 ± 0.85) then pre-diabetes (2.41 ± 0.88) then normoglycemia (2.61 ± 0.90). During follow-up, 45 patients experienced at least one MACE. On univariate Cox regression analysis, MPR and presence of silent IHD were both associated with MACE. However, after correction for HbA1c, age, and left ventricular ejection fraction, the associations were no longer significant. CONCLUSION Patients with DM and HF had higher prevalence of silent IHD, more evidence of CMD, and worse cardiovascular outcomes than their non-diabetic counterparts. These findings highlight the potential value of CMR for the assessment of silent IHD and CMD in patients with DM presenting with HF.
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Affiliation(s)
- Noor Sharrack
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Louise A E Brown
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Jonathan Farley
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Ali Wahab
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Nicholas Jex
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | | | - Amrit Chowdhary
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Miroslawa Gorecka
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Wasim Javed
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Hui Xue
- National Heart, Lung and Blood Institute, Bethesda, Maryland, USA
| | - Eylem Levelt
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Erica Dall'Armellina
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Peter Kellman
- National Heart, Lung and Blood Institute, Bethesda, Maryland, USA
| | - Pankaj Garg
- Cardiovascular and Metabolic Medicine Group, Norwich Medical School, University of East Anglia, Norwich, UK
| | - John P Greenwood
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Sven Plein
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Peter P Swoboda
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK.
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Madsen S, Kjaerulff MLG, Ejlersen JA, Ranghøj Nielsen BR, Jakobsen L, Sörensen J, Tolbod LP, Gormsen LC. Guiding early revascularization using [15O]H2O positron emission tomography myocardial perfusion imaging: impact of atrial fibrillation. Eur Heart J Cardiovasc Imaging 2024; 25:958-967. [PMID: 38376457 DOI: 10.1093/ehjci/jeae043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 12/20/2023] [Accepted: 02/03/2024] [Indexed: 02/21/2024] Open
Abstract
AIMS Myocardial perfusion imaging (MPI) using [15O]H2O positron emission tomography (PET) is used to guide the selection of patients with angina for invasive angiography and possible revascularization. Our study evaluated (i) whether atrial fibrillation (AF) reduces global hyperaemic myocardial blood flow (MBF) and (ii) whether [15O]H2O PET MPI effectively guides revascularization procedures for patients with ongoing AF. METHODS AND RESULTS We prospectively recruited 346 patients with angina and persistent or paroxysmal AF referred for baseline/hyperaemic [15O]H2O PET MPI. The primary outcome was revascularization within 3 months of MPI. In the analyses, patients were divided into four groups based on whether they had ongoing AF or sinus rhythm (SR) and whether they had previously documented coronary artery disease (CAD) or not. Thus, four groups were compared: SR-noCAD, AF-noCAD, SR-CAD, and AF-CAD. Hyperaemic MBF was affected by both ongoing AF and prior CAD [MBF (mL/min/g): 2.82 (SR-noCAD) vs. 2.12 (AF-noCAD) vs. 2.22 (SR-CAD) vs. 1.80 (AF-CAD), two-way analysis of variance P < 0.0001]. In multiple linear regression, ongoing AF was independently associated with reduced hyperaemic MBF. Every 0.1 mL/min/g decrease in hyperaemic MBF was associated with a 23% increase in odds of early revascularization. Receiver operating characteristic (ROC) analysis of vessel-specific hyperaemic MBF to predict early revascularization yielded the following areas under the ROC curve: SR-noCAD: 0.95 (P < 0.0001); AF-noCAD: 0.79 (P < 0.0001); SR-CAD: 0.78 (P < 0.0001); and AF-CAD: 0.88 (P < 0.0001). CONCLUSION Ongoing AF is associated with 19-25% reduced global hyperaemic MBF as measured by [15O]H2O MPI PET. Regardless, vessel-specific hyperaemic MBF still predicts early revascularization in patients with AF.
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Affiliation(s)
- Simon Madsen
- Department of Nuclear Medicine & PET-Centre, Aarhus University Hospital, Palle Juul-Jensens Boulevard 165, Aarhus N DK-8200, Denmark
| | - Mette Louise Gram Kjaerulff
- Department of Nuclear Medicine & PET-Centre, Aarhus University Hospital, Palle Juul-Jensens Boulevard 165, Aarhus N DK-8200, Denmark
| | - June Anita Ejlersen
- Department of Physiology and Nuclear Medicine, Regional Hospital Viborg, Viborg, Denmark
| | | | - Lars Jakobsen
- Department of Cardiology, Aarhus University Hospital, Aarhus N, Denmark
| | - Jens Sörensen
- Department of Nuclear Medicine & PET-Centre, Aarhus University Hospital, Palle Juul-Jensens Boulevard 165, Aarhus N DK-8200, Denmark
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard, 998200 Aarhus N, Denmark
| | - Lars Poulsen Tolbod
- Department of Nuclear Medicine & PET-Centre, Aarhus University Hospital, Palle Juul-Jensens Boulevard 165, Aarhus N DK-8200, Denmark
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard, 998200 Aarhus N, Denmark
| | - Lars Christian Gormsen
- Department of Nuclear Medicine & PET-Centre, Aarhus University Hospital, Palle Juul-Jensens Boulevard 165, Aarhus N DK-8200, Denmark
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard, 998200 Aarhus N, Denmark
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Cadour F, Cour A, Senlis J, Rapacchi S, Chennoufi H, Michelin P, McQuade C, Demeyere M, Dacher JN. How to use MRI in cardiac disease with diastolic dysfunction? Br J Radiol 2024; 97:1203-1213. [PMID: 38574383 PMCID: PMC11186565 DOI: 10.1093/bjr/tqae071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Revised: 11/14/2023] [Accepted: 03/29/2024] [Indexed: 04/06/2024] Open
Abstract
Left ventricular (LV) diastolic dysfunction (DD) is an initially asymptomatic condition that can progress to heart failure, either with preserved or reduced ejection fraction. As such, DD is a growing public health problem. Impaired relaxation, the first stage of DD, is associated with altered LV filling. With progression, reducing LV compliance leads to restrictive cardiomyopathy. While cardiac magnetic resonance (CMR) imaging is the reference for LV systolic function assessment, transthoracic echocardiography (TTE) with Doppler flow measurements remains the standard for diastolic function assessment. Rather than simply replicating TTE measurements, CMR should complement and further advance TTE findings. We provide herein a step-by-step review of CMR findings in DD as well as imaging features which may help identify the underlying cause.
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Affiliation(s)
- Farah Cadour
- Cardiac Imaging Unit, Department of Radiology, University Hospital of Rouen, Rouen 76000, France
- UNIROUEN, Inserm U1096, UFR Médecine Pharmacie, Rouen 76000, France
| | - Adrien Cour
- Cardiac Imaging Unit, Department of Radiology, University Hospital of Rouen, Rouen 76000, France
| | - Jules Senlis
- Cardiac Imaging Unit, Department of Radiology, University Hospital of Rouen, Rouen 76000, France
| | - Stanislas Rapacchi
- Aix-Marseille University, CNRS, CRMBM, Marseille 13005, France
- APHM, CHU Timone, CEMEREM, Marseille 13005, France
| | - Hajer Chennoufi
- Cardiac Imaging Unit, Department of Radiology, University Hospital of Rouen, Rouen 76000, France
| | - Paul Michelin
- Cardiac Imaging Unit, Department of Radiology, University Hospital of Rouen, Rouen 76000, France
| | - Colin McQuade
- Department of Medical Imaging, University Medical Imaging Toronto, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON M5G 2N2, Canada
| | - Matthieu Demeyere
- Cardiac Imaging Unit, Department of Radiology, University Hospital of Rouen, Rouen 76000, France
| | - Jean-Nicolas Dacher
- Cardiac Imaging Unit, Department of Radiology, University Hospital of Rouen, Rouen 76000, France
- UNIROUEN, Inserm U1096, UFR Médecine Pharmacie, Rouen 76000, France
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Zhang W, Liu L, Yin G, Mohammed AQ, Xiang L, Lv X, Shi T, Galip J, Wang C, Mohammed AA, Mareai RM, Yu F, Abdu FA, Che W. Triglyceride-glucose index is associated with myocardial ischemia and poor prognosis in patients with ischemia and no obstructive coronary artery disease. Cardiovasc Diabetol 2024; 23:187. [PMID: 38822373 PMCID: PMC11140859 DOI: 10.1186/s12933-024-02230-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Accepted: 04/09/2024] [Indexed: 06/03/2024] Open
Abstract
BACKGROUND Ischemia and no obstructive coronary artery disease (INOCA) is increasingly recognized and associated with poor outcomes. The triglyceride-glucose (TyG) index is a reliable alternative measure of insulin resistance significantly linked to cardiovascular disease and adverse prognosis. We investigated the association between the TyG index and myocardial ischemia and the prognosis in INOCA patients. METHODS INOCA patients who underwent both coronary angiography and myocardial perfusion imaging (MPI) were included consecutively. All participants were divided into three groups according to TyG tertiles (T1, T2, and T3). Abnormal MPI for myocardial ischemia in individual coronary territories was defined as summed stress score (SSS) ≥ 4 and summed difference score (SDS) ≥ 2. SSS refers to the sum of all defects in the stress images, and SDS is the difference of the sum of all defects between the rest images and stress images. All patients were followed up for major adverse cardiac events (MACE). RESULTS Among 332 INOCA patients, 113 (34.0%) had abnormal MPI. Patients with higher TyG index had a higher rate of abnormal MPI (25.5% vs. 32.4% vs. 44.1%; p = 0.012). Multivariate logistic analysis showed that a high TyG index was significantly correlated with abnormal MPI in INOCA patients (OR, 1.901; 95% CI, 1.045-3.458; P = 0.035). During the median 35 months of follow-up, 83 (25%) MACE were recorded, and a higher incidence of MACE was observed in the T3 group (T3 vs. T2 vs. T1: 36.9% vs. 21.6% vs. 16.4%, respectively; p = 0.001). In multivariate Cox regression analysis, the T3 group was significantly associated with the risk of MACE compared to the T1 group (HR, 2.338; 95% CI 1.253-4.364, P = 0.008). CONCLUSION This study indicates for the first time that the TyG index is significantly associated with myocardial ischemia and poor prognosis among INOCA patients.
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Affiliation(s)
- Wen Zhang
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301 Yanchang Road, Shanghai, 200072, China
| | - Lu Liu
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301 Yanchang Road, Shanghai, 200072, China
| | - Guoqing Yin
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301 Yanchang Road, Shanghai, 200072, China
| | - Abdul-Quddus Mohammed
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301 Yanchang Road, Shanghai, 200072, China
| | - Lanqing Xiang
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301 Yanchang Road, Shanghai, 200072, China
| | - Xian Lv
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301 Yanchang Road, Shanghai, 200072, China
| | - Tingting Shi
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301 Yanchang Road, Shanghai, 200072, China
| | - Jassur Galip
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301 Yanchang Road, Shanghai, 200072, China
| | - Chunyue Wang
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301 Yanchang Road, Shanghai, 200072, China
| | - Ayman A Mohammed
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301 Yanchang Road, Shanghai, 200072, China
| | - Redhwan M Mareai
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301 Yanchang Road, Shanghai, 200072, China
| | - Fei Yu
- Department of Nuclear Medicine, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Fuad A Abdu
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301 Yanchang Road, Shanghai, 200072, China.
| | - Wenliang Che
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301 Yanchang Road, Shanghai, 200072, China.
- Department of Cardiology, Shanghai Tenth People's Hospital Chongming branch, Shanghai, China.
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9
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Tune JD, Warne CM, Essajee SI, Tucker SM, Figueroa CA, Dick GM, Beard DA. Unraveling the Gordian knot of coronary pressure-flow autoregulation. J Mol Cell Cardiol 2024; 190:82-91. [PMID: 38608928 DOI: 10.1016/j.yjmcc.2024.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 03/27/2024] [Accepted: 04/09/2024] [Indexed: 04/14/2024]
Abstract
The coronary circulation has the inherent ability to maintain myocardial perfusion constant over a wide range of perfusion pressures. The phenomenon of pressure-flow autoregulation is crucial in response to flow-limiting atherosclerotic lesions which diminish coronary driving pressure and increase risk of myocardial ischemia and infarction. Despite well over half a century of devoted research, understanding of the mechanisms responsible for autoregulation remains one of the most fundamental and contested questions in the field today. The purpose of this review is to highlight current knowledge regarding the complex interrelationship between the pathways and mechanisms proposed to dictate the degree of coronary pressure-flow autoregulation. Our group recently likened the intertwined nature of the essential determinants of coronary flow control to the symbolically unsolvable "Gordian knot". To further efforts to unravel the autoregulatory "knot", we consider recent challenges to the local metabolic and myogenic hypotheses and the complicated dynamic structural and functional heterogeneity unique to the heart and coronary circulation. Additional consideration is given to interrogation of putative mediators, role of K+ and Ca2+ channels, and recent insights from computational modeling studies. Improved understanding of how specific vasoactive mediators, pathways, and underlying disease states influence coronary pressure-flow relations stands to significantly reduce morbidity and mortality for what remains the leading cause of death worldwide.
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Affiliation(s)
- Johnathan D Tune
- Department of Physiology and Anatomy, University of North Texas Health Science Center, USA.
| | - Cooper M Warne
- Department of Physiology and Anatomy, University of North Texas Health Science Center, USA
| | - Salman I Essajee
- Department of Physiology and Anatomy, University of North Texas Health Science Center, USA
| | - Selina M Tucker
- Department of Physiology and Anatomy, University of North Texas Health Science Center, USA
| | - C Alberto Figueroa
- Section of Vascular Surgery, Department of Surgery, University of Michigan, USA; Department of Biomedical Engineering, University of Michigan, USA
| | - Gregory M Dick
- Department of Physiology and Anatomy, University of North Texas Health Science Center, USA
| | - Daniel A Beard
- Department of Molecular and Integrative Physiology, University of Michigan, USA
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10
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Lav Madsen P, Sejersen C, Nyberg M, Sørensen MH, Hellsten Y, Gaede P, Bojer AS. The cardiovascular changes underlying a low cardiac output with exercise in patients with type 2 diabetes mellitus. Front Physiol 2024; 15:1294369. [PMID: 38571722 PMCID: PMC10987967 DOI: 10.3389/fphys.2024.1294369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 02/19/2024] [Indexed: 04/05/2024] Open
Abstract
The significant morbidity and premature mortality of type 2 diabetes mellitus (T2DM) is largely associated with its cardiovascular consequences. Focus has long been on the arterial atheromatosis of DM giving rise to early stroke and myocardial infarctions, whereas less attention has been given to its non-ischemic cardiovascular consequences. Irrespective of ischemic changes, T2DM is associated with heart failure (HF) most commonly with preserved ejection fraction (HFpEF). Largely due to increasing population ages, hypertension, obesity and T2DM, HFpEF is becoming the most prevalent form of heart failure. Unfortunately, randomized controlled trials of HFpEF have largely been futile, and it now seems logical to address the important different phenotypes of HFpEF to understand their underlying pathophysiology. In the early phases, HFpEF is associated with a significantly impaired ability to increase cardiac output with exercise. The lowered cardiac output with exercise results from both cardiac and peripheral causes. T2DM is associated with left ventricular (LV) diastolic dysfunction based on LV hypertrophy with myocardial disperse fibrosis and significantly impaired ability for myocardial blood flow increments with exercise. T2DM is also associated with impaired ability for skeletal muscle vasodilation during exercise, and as is the case in the myocardium, such changes may be related to vascular rarefaction. The present review discusses the underlying phenotypical changes of the heart and peripheral vascular system and their importance for an adequate increase in cardiac output. Since many of the described cardiovascular changes with T2DM must be considered difficult to change if fully developed, it is suggested that patients with T2DM are early evaluated with respect to their cardiovascular compromise.
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Affiliation(s)
- Per Lav Madsen
- Department Cardiology, Herlev-Gentofte Hospital, Copenhagen University, Copenhagen, Denmark
- Department Clinical Medicine, Copenhagen University, Copenhagen, Denmark
- The August Krogh Section for Human Physiology, Department Nutrition, Exercise and Sports, Copenhagen University, Copenhagen, Denmark
| | - Casper Sejersen
- The August Krogh Section for Human Physiology, Department Nutrition, Exercise and Sports, Copenhagen University, Copenhagen, Denmark
- Department of Anaesthesia, Rigshospitalet, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Michael Nyberg
- Department Kidney and Vascular Biology, Global Drug Discovery, Novo Nordisk, Copenhagen, Denmark
| | | | - Ylva Hellsten
- The August Krogh Section for Human Physiology, Department Nutrition, Exercise and Sports, Copenhagen University, Copenhagen, Denmark
| | - Peter Gaede
- Department Endocrinology, Slagelse-Næstved Hospital, Copenhagen, Denmark
| | - Annemie Stege Bojer
- Department Cardiology, Herlev-Gentofte Hospital, Copenhagen University, Copenhagen, Denmark
- Department Endocrinology, Slagelse-Næstved Hospital, Copenhagen, Denmark
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11
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Zhao W, Li K, Tang L, Zhang J, Guo H, Zhou X, Luo M, Liu H, Cui R, Zeng M. Coronary Microvascular Dysfunction and Diffuse Myocardial Fibrosis in Patients With Type 2 Diabetes Using Quantitative Perfusion MRI. J Magn Reson Imaging 2024. [PMID: 38376091 DOI: 10.1002/jmri.29296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 01/30/2024] [Accepted: 01/30/2024] [Indexed: 02/21/2024] Open
Abstract
BACKGROUND Imaging techniques that quantitatively and automatically measure changes in the myocardial microcirculation in patients with diabetes are lacking. PURPOSE To detect diabetic myocardial microvascular complications using a novel automatic quantitative perfusion MRI technique, and to explore the relationship between myocardial microcirculation dysfunction and fibrosis. STUDY TYPE Prospective. SUBJECTS 101 patients with type 2 diabetes mellitus (T2DM) (53 without and 48 with complications), 20 healthy volunteers. FIELD STRENGTH/SEQUENCE 3.0T; modified Look-Locker inversion-recovery sequence; saturation recovery sequence and dual-bolus technique; segmented fast low-angle shot sequence. ASSESSMENT All participants underwent MRI to determine the rest myocardial blood flow (MBF), stress MBF, myocardial perfusion reserve (MPR), and extracellular volume (ECV), which represents the extent of myocardial fibrosis. STATISTICAL TESTS Kolmogorov-Smirnov test, Shapiro-Wilk test, Kruskal-Wallis H test, Mann-Whitney U test, chi-square test, Spearman correlation coefficient, multivariable linear regression analysis. P < 0.05 was considered statistically significant. RESULTS The rest MBF was not significantly different between the T2DM without complications group (1.1, IQR: 0.9-1.3) and the control group (1.1, 1.0-1.3) (P = 1.000), but it was significantly lower in the T2DM with complications group (0.8, 0.6-1.0) than in both other groups. The stress MBF and MPR were significantly lower in the T2DM without complications group (1.9, 1.5-2.3, and 1.7, 1.4-2.1, respectively) than in the control group (3.0, 2.6-3.5, and 2.7, 2.4-3.1, respectively), and were also significantly lower in the T2DM with complications group (1.1, 0.9-1.4, and 1.4, 1.2-1.8, respectively) than in the T2DM without complications group. A decrease in MBF and MPR were significantly associated with an increase in the ECV. DATA CONCLUSION Quantitative perfusion MRI can evaluate myocardial microcirculation dysfunction. In T2DM, there was a significant decrease in both MBF and MPR compared to healthy controls, with the decrease being significantly different between T2DM with and without complications groups. The decrease of MBF was significantly associated with the development of myocardial fibrosis, as determined by ECV. LEVEL OF EVIDENCE 2 TECHNICAL EFFICACY: Stage 3.
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Affiliation(s)
- Wenjin Zhao
- Department of Radiology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Kang Li
- Department of Radiology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Leting Tang
- Department of Radiology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Jiamin Zhang
- Department of Radiology, The Third Affiliated Hospital of Xinxiang Medical University, Xinxiang, Henan, China
| | - Hu Guo
- MR Application, Siemens Healthineers Ltd., Changsha, China
| | - Xiaoyue Zhou
- MR Collaboration, Siemens Healthineers Ltd., Shanghai, China
| | - Meichen Luo
- Circle Cardiovascular Imaging Inc., Calgary, Alberta, Canada
| | - Hongduan Liu
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Rongrong Cui
- National Clinical Research Center for Metabolic Diseases, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
- Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Mu Zeng
- Department of Radiology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
- Clinical Research Center for Medical Imaging in Hunan Province, Changsha, China
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12
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Bojer AS, Sørensen MH, Madsen SH, Broadbent DA, Plein S, Gæde P, Madsen PL. Early signs of myocardial systolic dysfunction in patients with type 2 diabetes are strongly associated with myocardial microvascular dysfunction independent of myocardial fibrosis: a prospective cohort study. Diabetol Metab Syndr 2024; 16:41. [PMID: 38350975 PMCID: PMC10863286 DOI: 10.1186/s13098-024-01285-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 02/04/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND Patients with diabetes demonstrate early left ventricular systolic dysfunction. Notably reduced global longitudinal strain (GLS) is related to poor outcomes, the underlying pathophysiology is however still not clearly understood. We hypothesized that pathophysiologic changes with microvascular dysfunction and interstitial fibrosis contribute to reduced strain. METHODS 211 patients with type 2 diabetes and 25 control subjects underwent comprehensive cardiovascular phenotyping by magnetic resonance imaging. Myocardial blood flow (MBF), perfusion reserve (MPR), extracellular volume (ECV), and 3D feature tracking GLS and global circumferential (GCS) and radial strain (GRS) were quantified. RESULTS Patients (median age 57 [IQR 50, 67] years, 70% males) had a median diabetes duration of 12 [IQR 6, 18] years. Compared to control subjects GLS, GCS, and GRS were reduced in the total diabetes cohort, and GLS was also reduced in the sub-group of patients without diabetic complications compared to control subjects (controls - 13.9 ± 2.0%, total cohort - 11.6 ± 3.0%; subgroup - 12.3 ± 2.6%, all p < 0.05). Reduced GLS, but not GCS or GRS, was associated with classic diabetes complications of albuminuria (UACR ≥ 30 mg/g) [β (95% CI) 1.09 (0.22-1.96)] and autonomic neuropathy [β (95% CI) 1.43 (0.54-2.31)] but GLS was not associated with retinopathy or peripheral neuropathy. Independently of ECV, a 10% increase in MBF at stress and MPR was associated with higher GLS [multivariable regression adjusted for age, sex, hypertension, smoking, and ECV: MBF stress (β (95% CI) - 0.2 (- 0.3 to - 0.08), MPR (β (95% CI) - 0.5 (- 0.8 to - 0.3), p < 0.001 for both]. A 10% increase in ECV was associated with a decrease in GLS in univariable [β (95% CI) 0.6 (0.2 to 1.1)] and multivariable regression, but this was abolished when adjusted for MPR [multivariable regression adjusted for age, sex, hypertension, smoking, and MPR (β (95% CI) 0.1 (- 0.3 to 0.6)]. On the receiver operating characteristics curve, GLS showed a moderate ability to discriminate a significantly lowered stress MBF (AUC 0.72) and MPR (AUC 0.73). CONCLUSIONS Myocardial microvascular dysfunction was independent of ECV, a biomarker of myocardial fibrosis, associated with GLS. Further, 3D GLS could be a potential screening tool for myocardial microvascular dysfunction. Future directions should focus on confirming these results in longitudinal and/or interventional studies.
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Affiliation(s)
- Annemie S Bojer
- Department of Cardiology and Endocrinology, Slagelse Hospital, Ingemannsvej 32, 4200, Slagelse, Region Zealand, Denmark.
- Department of Cardiology, Copenhagen University Hospital Herlev-Gentofte, Herlev, Capital Region of Denmark, Denmark.
| | - Martin H Sørensen
- Department of Cardiology and Endocrinology, Slagelse Hospital, Ingemannsvej 32, 4200, Slagelse, Region Zealand, Denmark
| | - Stine H Madsen
- Department of Cardiology, Copenhagen University Hospital Herlev-Gentofte, Herlev, Capital Region of Denmark, Denmark
| | - David A Broadbent
- Department of Medical Physics and Engineering, Leeds Teaching Hospitals NHS Trust, Leeds, UK
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Sven Plein
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Peter Gæde
- Department of Cardiology and Endocrinology, Slagelse Hospital, Ingemannsvej 32, 4200, Slagelse, Region Zealand, Denmark
- Faculty of Health Sciences, Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Per L Madsen
- Department of Cardiology, Copenhagen University Hospital Herlev-Gentofte, Herlev, Capital Region of Denmark, Denmark
- Department of Clinical Medicine, Copenhagen University, Copenhagen, Denmark
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13
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Cutruzzolà A, Parise M, Cozza P, Moraru S, Gnasso A, Irace C. Elevated blood flow in people with type 1 and type 2 diabetes. Diabetes Res Clin Pract 2024; 208:111110. [PMID: 38278495 DOI: 10.1016/j.diabres.2024.111110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 01/15/2024] [Accepted: 01/17/2024] [Indexed: 01/28/2024]
Abstract
AIMS The study aimed to evaluate blood flow (BF) and microvascular function in the forearm of people with type 1 and type 2 diabetes at rest and after ischemia. Microvascular function plays a crucial role in regulating BF in peripheral tissues based on metabolic demand. METHODS People with diabetes and sex-matched healthy controls were recruited. Brachial artery diameter and blood velocity were continuously measured at rest and after ischemia by an automatic tracking system. BF and vascular conductance were then calculated. RESULTS Forty-nine people with diabetes and 49 controls were enrolled. BF at rest and after ischemia was significantly higher in people with diabetes than controls: Type 1, 243 ± 116 and 631 ± 233 ml/min; controls, 180 ± 106 and 486 ± 227 ml/min; Type 2, 332 ± 149 and 875 ± 293 ml/min; controls 222 ± 106 and 514 ± 224 ml/min. Vascular conductance was significantly higher in Type 2 than in controls at rest and after ischemia. CONCLUSIONS People with diabetes exhibited significantly increased BF, with Type 2 also showing heightened vascular conductance. Activating metabolic pathways triggered by hyperglycemia may lead to distinct vascular redistribution, potentially impairing blood flow over time. These findings of the study underscore the importance of understanding overall vascular dynamics in diabetes and its implications for vascular health.
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Affiliation(s)
- Antonio Cutruzzolà
- Department of Clinical and Experimental Medicine, University Magna Græcia, Catanzaro, Italy
| | - Martina Parise
- Department of Health Science, University Magna Græcia, Catanzaro, Italy
| | - Pasquale Cozza
- School of Medicine, University Magna Græcia, Catanzaro, Italy
| | - Stefan Moraru
- School of Medicine, University Magna Græcia, Catanzaro, Italy
| | - Agostino Gnasso
- Department of Clinical and Experimental Medicine, University Magna Græcia, Catanzaro, Italy
| | - Concetta Irace
- Department of Health Science, University Magna Græcia, Catanzaro, Italy.
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14
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Jiang L, Yan WF, Zhang L, Xu HY, Guo YK, Li ZL, Liu KL, Zeng LM, Li Y, Yang ZG. Early left ventricular microvascular dysfunction in diabetic pigs: a longitudinal quantitative myocardial perfusion CMR study. Cardiovasc Diabetol 2024; 23:9. [PMID: 38184602 PMCID: PMC10771679 DOI: 10.1186/s12933-023-02106-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 12/27/2023] [Indexed: 01/08/2024] Open
Abstract
BACKGROUND Microvascular pathology is one of the main characteristics of diabetic cardiomyopathy; however, the early longitudinal course of diabetic microvascular dysfunction remains uncertain. This study aimed to investigate the early dynamic changes in left ventricular (LV) microvascular function in diabetic pig model using the cardiac magnetic resonance (CMR)-derived quantitative perfusion technique. METHODS Twelve pigs with streptozotocin-induced diabetes mellitus (DM) were included in this study, and longitudinal CMR scanning was performed before and 2, 6, 10, and 16 months after diabetic modeling. CMR-derived semiquantitative parameters (upslope, maximal signal intensity, perfusion index, and myocardial perfusion reserve index [MPRI]) and fully quantitative perfusion parameters (myocardial blood flow [MBF] and myocardial perfusion reserve [MPR]) were analyzed to evaluate longitudinal changes in LV myocardial microvascular function. Pearson correlation was used to analyze the relationship between LV structure and function and myocardial perfusion function. RESULTS With the progression of DM duration, the upslope at rest showed a gradually increasing trend (P = 0.029); however, the upslope at stress and MBF did not change significantly (P > 0.05). Regarding perfusion reserve function, both MPRI and MPR showed a decreasing trend with the progression of disease duration (MPRI, P = 0.001; MPR, P = 0.042), with high consistency (r = 0.551, P < 0.001). Furthermore, LV MPR is moderately associated with LV longitudinal strain (r = - 0.353, P = 0.022), LV remodeling index (r = - 0.312, P = 0.033), fasting blood glucose (r = - 0.313, P = 0.043), and HbA1c (r = - 0.309, P = 0.046). Microscopically, pathological results showed that collagen volume fraction increased gradually, whereas no significant decrease in microvascular density was observed with the progression of DM duration. CONCLUSIONS Myocardial microvascular reserve function decreased gradually in the early stage of DM, which is related to both structural (but not reduced microvascular density) and functional abnormalities of microvessels, and is associated with increased blood glucose, reduced LV deformation, and myocardial remodeling.
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Affiliation(s)
- Li Jiang
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, Sichuan, 610041, China
| | - Wei-Feng Yan
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, Sichuan, 610041, China
| | - Lu Zhang
- Department of Radiology, Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, West China Second University Hospital, Sichuan University, 20# South Renmin Road, Chengdu, Sichuan, 610041, China
| | - Hua-Yan Xu
- Department of Radiology, Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, West China Second University Hospital, Sichuan University, 20# South Renmin Road, Chengdu, Sichuan, 610041, China
| | - Ying-Kun Guo
- Department of Radiology, Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, West China Second University Hospital, Sichuan University, 20# South Renmin Road, Chengdu, Sichuan, 610041, China
| | - Zhen-Lin Li
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, Sichuan, 610041, China
| | - Ke-Ling Liu
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, Sichuan, 610041, China
| | - Ling-Ming Zeng
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, Sichuan, 610041, China
| | - Yuan Li
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, Sichuan, 610041, China
| | - Zhi-Gang Yang
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, Sichuan, 610041, China.
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15
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Székely A, Steding-Ehrenborg K, Ryd D, Hedeer F, Valind K, Akil S, Hindorf C, Hedström E, Erlinge D, Arheden H, Engblom H. Quantitative myocardial perfusion should be interpreted in the light of sex and comorbidities in patients with suspected chronic coronary syndrome: A cardiac positron emission tomography study. Clin Physiol Funct Imaging 2024; 44:89-99. [PMID: 37642142 DOI: 10.1111/cpf.12854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 06/13/2023] [Accepted: 08/22/2023] [Indexed: 08/31/2023]
Abstract
Diagnosis and treatment of patients with suspected chronic coronary syndrome (CCS) currently relies on the degree of coronary artery stenosis and its significance for myocardial perfusion. However, myocardial perfusion can be affected by factors other than coronary stenosis. The aim of this study was to investigate to what extent sex, age, diabetes, hypertension and smoking affect quantitative myocardial perfusion, beyond the degree of coronary artery stenosis, in patients with suspected or established CCS. Eighty-six patients [median age 69 (range 46-86) years, 24 females] planned for elective coronary angiography due to suspected or established CCS were included. All patients underwent cardiac 13 N-NH3 positron emission tomography to quantify myocardial perfusion at rest and stress. Lowest myocardial perfusion (perfusionmin ) at stress and rest and lowest myocardial perfusion reserve (MPRmin ) for all vessel territories was used as dependent variables in a linear mixed model. Independent variables were vessel territory, degree of coronary artery stenosis (as a continuous variable of 0%-100% stenosis), sex, age, diabetes, hypertension and smoking habits. Degree of coronary artery stenosis (p < 0.001), male sex (1.8 ± 0.6 vs. 2.3 ± 0.6 mL/min/g, p < 0.001), increasing age (p = 0.025), diabetes (1.6 ± 0.5 vs. 2.0 ± 0.6 mL/min/g, p = 0.023) and smoking (1.9 ± 0.6 vs. 2.1 ± 0.6 mL/min/g, p = 0.052) were independently associated with myocardial perfusionmin at stress. Degree of coronary artery stenosis (p < 0.001), age (p = 0.040), diabetes (1.8 ± 0.6 vs. 2.3 ± 0.7, p = 0.046) and hypertension (2.2 ± 0.7 vs. 2.5 ± 0.6, p = 0.033) were independently associated with MPRmin . Sex, increasing age, diabetes, hypertension and smoking affect myocardial perfusion independent of coronary artery stenosis in patients with suspected or established CCS. Thus, these factors need to be considered when assessing the significance of reduced quantitative myocardial perfusion of patients with suspected or established CCS.
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Affiliation(s)
- Anna Székely
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Katarina Steding-Ehrenborg
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Daniel Ryd
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Fredrik Hedeer
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Kristian Valind
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Shahnaz Akil
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Cecilia Hindorf
- Department of Medical Radiation Physics, Lund University, Lund, Sweden
| | - Erik Hedström
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
- Diagnostic Radiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - David Erlinge
- Cardiology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Håkan Arheden
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Henrik Engblom
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
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16
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Bojer AS, Sørensen MH, Madsen SH, Broadbent DA, Plein S, Gæde P, Madsen PL. The independent association of myocardial extracellular volume and myocardial blood flow with cardiac diastolic function in patients with type 2 diabetes: a prospective cross-sectional cohort study. Cardiovasc Diabetol 2023; 22:78. [PMID: 37004049 PMCID: PMC10067250 DOI: 10.1186/s12933-023-01804-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 03/16/2023] [Indexed: 04/03/2023] Open
Abstract
BACKGROUND Diffuse myocardial fibrosis and microvascular dysfunction are suggested to underlie cardiac dysfunction in patients with type 2 diabetes, but studies investigating their relative impact are lacking. We aimed to study imaging biomarkers of these and hypothesized that fibrosis and microvascular dysfunction would affect different phases of left ventricular (LV) diastole. METHODS In this cross-sectional study myocardial blood flow (MBF) at rest and adenosine-stress and perfusion reserve (MPR), as well as extracellular volume fraction (ECV), were determined with cardiovascular magnetic resonance (CMR) imaging in 205 patients with type 2 diabetes and 25 controls. Diastolic parameters included echocardiography-determined lateral e' and average E/e', and CMR-determined (rest and chronotropic-stress) LV early peak filling rate (ePFR), LV peak diastolic strain rate (PDSR), and left atrial (LA) volume changes. RESULTS In multivariable analysis adjusted for possible confounders including each other (ECV for blood flow and vice versa), a 10% increase of ECV was independently associated with ePFR/EDV (rest: β = - 4.0%, stress: β = - 7.9%), LAmax /BSA (rest: β = 4.8%, stress: β = 5.8%), and circumferential (β = - 4.1%) and radial PDSR (β = 0.07%/sec). A 10% stress MBF increase was associated with lateral e' (β = 1.4%) and average E/e' (β = - 1.4%) and a 10% MPR increase to lateral e' (β = 2.7%), and average E/e' (β = - 2.8%). For all the above, p < 0.05. No associations were found with longitudinal PDSR or left atrial total emptying fraction. CONCLUSION In patients with type 2 diabetes, imaging biomarkers of microvascular dysfunction and diffuse fibrosis impacts diastolic dysfunction independently of each other. Microvascular dysfunction primarily affects early left ventricular relaxation. Diffuse fibrosis primarily affects diastasis. Trial registration https://www. CLINICALTRIALS gov . Unique identifier: NCT02684331. Date of registration: February 18, 2016.
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Affiliation(s)
- Annemie S Bojer
- Department of Cardiology and Endocrinology, Slagelse Hospital, Ingemannsvej 32, Region Zealand, 4200, Slagelse, Denmark.
- Institute of Regional Health Research, Faculty of Health Sciences, University of Southern, Odense, Denmark.
| | - Martin H Sørensen
- Department of Cardiology and Endocrinology, Slagelse Hospital, Ingemannsvej 32, Region Zealand, 4200, Slagelse, Denmark
| | - Stine H Madsen
- Department of Cardiology, Copenhagen University Hospital Herlev-Gentofte, Capital Region of Denmark, Hellerup, Denmark
| | - David A Broadbent
- Department of Medical Physics and Engineering, Leeds Teaching Hospitals NHS Trust, Leeds, UK
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Sven Plein
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Peter Gæde
- Department of Cardiology and Endocrinology, Slagelse Hospital, Ingemannsvej 32, Region Zealand, 4200, Slagelse, Denmark
- Institute of Regional Health Research, Faculty of Health Sciences, University of Southern, Odense, Denmark
| | - Per L Madsen
- Department of Cardiology, Copenhagen University Hospital Herlev-Gentofte, Capital Region of Denmark, Hellerup, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Zhou W, Sin J, Yan AT, Wang H, Lu J, Li Y, Kim P, Patel AR, Ng MY. Qualitative and Quantitative Stress Perfusion Cardiac Magnetic Resonance in Clinical Practice: A Comprehensive Review. Diagnostics (Basel) 2023; 13:524. [PMID: 36766629 PMCID: PMC9914769 DOI: 10.3390/diagnostics13030524] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 01/11/2023] [Accepted: 01/28/2023] [Indexed: 02/05/2023] Open
Abstract
Stress cardiovascular magnetic resonance (CMR) imaging is a well-validated non-invasive stress test to diagnose significant coronary artery disease (CAD), with higher diagnostic accuracy than other common functional imaging modalities. One-stop assessment of myocardial ischemia, cardiac function, and myocardial viability qualitatively and quantitatively has been proven to be a cost-effective method in clinical practice for CAD evaluation. Beyond diagnosis, stress CMR also provides prognostic information and guides coronary revascularisation. In addition to CAD, there is a large body of literature demonstrating CMR's diagnostic performance and prognostic value in other common cardiovascular diseases (CVDs), especially coronary microvascular dysfunction (CMD). This review focuses on the clinical applications of stress CMR, including stress CMR scanning methods, practical interpretation of stress CMR images, and clinical utility of stress CMR in a setting of CVDs with possible myocardial ischemia.
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Affiliation(s)
- Wenli Zhou
- Department of Radiology, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, No. 600, Yishan Road, Shanghai 200233, China
| | - Jason Sin
- Department of Diagnostic Radiology, The University of Hong Kong, Hong Kong SAR, China
| | - Andrew T. Yan
- St. Michael’s Hospital, University of Toronto, Toronto, ON M5B 1W8, Canada
| | | | - Jing Lu
- Department of Radiology, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, No. 600, Yishan Road, Shanghai 200233, China
| | - Yuehua Li
- Department of Radiology, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, No. 600, Yishan Road, Shanghai 200233, China
| | - Paul Kim
- Department of Medicine, University of California San Diego, San Diego, CA 92093, USA
| | - Amit R. Patel
- Department of Cardiovascular Medicine, University of Virginia, Charlottesville, VA 22903, USA
| | - Ming-Yen Ng
- Department of Medical Imaging, HKU-Shenzhen Hospital, Shenzhen 518009, China
- Department of Diagnostic Radiology, School of Clinical Medicine, The University of Hong Kong, Hong Kong SAR, China
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18
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Bojer AS, Sørensen MH, Gæde P, Madsen PL. Myocardial Extracellular Volume Expansion in Type 2 Diabetes Is Associated With Ischemic Heart Disease, Autonomic Neuropathy, and Active Smoking. Diabetes Care 2022; 45:3032-3039. [PMID: 36215704 DOI: 10.2337/dc22-0942] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 09/19/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Myocardial interstitial fibrosis expands the extracellular volume (ECV) and in patients with type 2 diabetes is implicated in development of heart failure. ECV can be determined with gadolinium contrast MRI. We investigated which known risk factors for cardiovascular disease were associated with increased ECV in patients with type 2 diabetes. RESEARCH DESIGN AND METHODS A total of 296 patients with type 2 diabetes and 25 sex and age-matched control subjects were included in a cross-sectional MRI study. The influence of risk factors on ECV was investigated with multiple regression analysis. RESULTS Control subjects and patients with type 2 diabetes without complications had similar ECV (mean ± SD 27.4 ± 2.1% vs. 27.9 ± 2.6%, P = 0.4). Compared with patients without, ECV was significantly increased in patients with one or more complications (29.0 ± 3.3%, P = 0.02). Both in univariable analysis and after multivariable adjustment, ischemic heart disease, autonomic neuropathy, and active smoking were associated with increased levels of ECV. Active smoking exhibited the largest effect size (β = 2.0 percentage points, 95% CI 0.7-3.3). Former smokers ECV similar to that of never smokers. Albuminuria and systolic blood pressure were inversely associated with ECV in multivariable analysis, but after adjustment for medication suspected to affect ECV, the association with albuminuria was no longer significant (P = 0.1). Sodium-glucose cotransporter 2 inhibitor treatment was not significantly associated with reduced ECV (-0.8%, 95% CI -1.7 to 0.06, P = 0.067). CONCLUSIONS Patients with complications of diabetes have increased ECV, not seen in patients without complications. Ischemic heart disease, autonomic neuropathy, and active but not former smoking were highly associated with increased ECV.
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Affiliation(s)
- Annemie Stege Bojer
- Department of Cardiology and Endocrinology, Slagelse Hospital, Slagelse, Denmark
| | - Martin Heyn Sørensen
- Department of Cardiology and Endocrinology, Slagelse Hospital, Slagelse, Denmark
| | - Peter Gæde
- Department of Cardiology and Endocrinology, Slagelse Hospital, Slagelse, Denmark.,Institute of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Per Lav Madsen
- Department of Cardiology, Copenhagen University Hospital Herlev-Gentofte, Herlev, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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19
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Wamil M, Goncalves M, Rutherford A, Borlotti A, Pellikka PA. Multi-modality cardiac imaging in the management of diabetic heart disease. Front Cardiovasc Med 2022; 9:1043711. [DOI: 10.3389/fcvm.2022.1043711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 10/17/2022] [Indexed: 11/06/2022] Open
Abstract
Diabetic heart disease is a major healthcare problem. Patients with diabetes show an excess of death from cardiovascular causes, twice as high as the general population and those with diabetes type 1 and longer duration of the disease present with more severe cardiovascular complications. Premature coronary artery disease and heart failure are leading causes of morbidity and reduced life expectancy. Multimodality cardiac imaging, including echocardiography, cardiac computed tomography, nuclear medicine, and cardiac magnetic resonance play crucial role in the diagnosis and management of different pathologies included in the definition of diabetic heart disease. In this review we summarise the utility of multi-modality cardiac imaging in characterising ischaemic and non-ischaemic causes of diabetic heart disease and give an overview of the current clinical practice. We also describe emerging imaging techniques enabling early detection of coronary artery inflammation and the non-invasive characterisation of the atherosclerotic plaque disease. Furthermore, we discuss the role of MRI-derived techniques in studying altered myocardial metabolism linking diabetes with the development of diabetic cardiomyopathy. Finally, we discuss recent data regarding the use of artificial intelligence applied to large imaging databases and how those efforts can be utilised in the future in screening of patients with diabetes for early signs of disease.
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20
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Bradley C, Berry C. Definition and epidemiology of coronary microvascular disease. J Nucl Cardiol 2022; 29:1763-1775. [PMID: 35534718 PMCID: PMC9345825 DOI: 10.1007/s12350-022-02974-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 02/17/2022] [Indexed: 11/18/2022]
Abstract
Ischemic heart disease remains one of the leading causes of death and disability worldwide. However, most patients referred for a noninvasive computed tomography coronary angiogram (CTA) or invasive coronary angiogram for the investigation of angina do not have obstructive coronary artery disease (CAD). Approximately two in five referred patients have coronary microvascular disease (CMD) as a primary diagnosis and, in addition, CMD also associates with CAD and myocardial disease (dual pathology). CMD underpins excess morbidity, impaired quality of life, significant health resource utilization, and adverse cardiovascular events. However, CMD often passes undiagnosed and the onward management of these patients is uncertain and heterogeneous. International standardized diagnostic criteria allow for the accurate diagnosis of CMD, ensuring an often overlooked patient population can be diagnosed and stratified for targeted medical therapy. Key to this is assessing coronary microvascular function-including coronary flow reserve, coronary microvascular resistance, and coronary microvascular spasm. This can be done by invasive methods (intracoronary temperature-pressure wire, intracoronary Doppler flow-pressure wire, intracoronary provocation testing) and non-invasive methods [positron emission tomography (PET), cardiac magnetic resonance imaging (CMR), transthoracic Doppler echocardiography (TTDE), cardiac computed tomography (CT)]. Coronary CTA is insensitive for CMD. Functional coronary angiography represents the combination of CAD imaging and invasive diagnostic procedures.
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Affiliation(s)
- Conor Bradley
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom
- NHS Golden Jubilee Hospital, Clydebank, United Kingdom
| | - Colin Berry
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom.
- NHS Golden Jubilee Hospital, Clydebank, United Kingdom.
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, 126 University Place, Glasgow, G12 8TA, Scotland, United Kingdom.
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21
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Chowdhary A, Thirunavukarasu S, Jex N, Coles L, Bowers C, Sengupta A, Swoboda P, Witte K, Cubbon R, Xue H, Kellman P, Greenwood J, Plein S, Levelt E. Coronary microvascular function and visceral adiposity in patients with normal body weight and type 2 diabetes. Obesity (Silver Spring) 2022; 30:1079-1090. [PMID: 35357083 PMCID: PMC9314597 DOI: 10.1002/oby.23413] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 02/10/2022] [Accepted: 02/12/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVE This study sought to assess whether diabetes affects coronary microvascular function in individuals with normal body weight. METHODS Seventy-five participants (30 patients with type 2 diabetes [T2D] who were overweight [O-T2D], 15 patients with T2D who were lean [LnT2D], 15 healthy volunteers who were lean [LnHV], and 15 healthy volunteers who were overweight [O-HV]) without established cardiovascular disease were recruited. Participants underwent magnetic resonance imaging for assessment of subcutaneous, epicardial, and visceral adipose tissue areas, adenosine stress myocardial blood flow (MBF), and cardiac structure and function. RESULTS Stress MBF was reduced only in the O-T2D group (mean [SD], LnHV = 2.07 [0.47] mL/g/min, O-HV = 2.08 [0.42] mL/g/min, LnT2D = 2.16 [0.36] mL/g/min, O-T2D = 1.60 [0.28] mL/g/min; p ≤ 0.0001). Accumulation of visceral fat was evident in the LnT2D group at similar levels to the O-HV group (LnHV = 127 [53] cm2 , O-HV = 181 [60] cm2 , LnT2D = 182 [99] cm2 , O-T2D = 288 [72] cm2 ; p < 0.0001). Only the O-T2D group showed reductions in left ventricular ejection fraction (LnHV = 63% [4%], O-HV = 63% [4%], LnT2D = 60% [5%], O-T2D = 58% [6%]; p = 0.0008) and global longitudinal strain (LnHV = -15.1% [3.1%], O-HV= -15.2% [3.7%], LnT2D = -13.4% [2.7%], O-T2D = -11.1% [2.8%]; p = 0.002) compared with both control groups. CONCLUSIONS Patients with T2D and normal body weight do not show alterations in global stress MBF, but they do show significant increases in visceral adiposity. Patients with T2D who were overweight and had no prior cardiovascular disease showed an increase in visceral adiposity and significant reductions in stress MBF.
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Affiliation(s)
- Amrit Chowdhary
- Multidisciplinary Cardiovascular Research Centre and Biomedical Imaging Science DepartmentLeeds Institute of Cardiovascular and Metabolic MedicineUniversity of LeedsLeedsUK
| | - Sharmaine Thirunavukarasu
- Multidisciplinary Cardiovascular Research Centre and Biomedical Imaging Science DepartmentLeeds Institute of Cardiovascular and Metabolic MedicineUniversity of LeedsLeedsUK
| | - Nicholas Jex
- Multidisciplinary Cardiovascular Research Centre and Biomedical Imaging Science DepartmentLeeds Institute of Cardiovascular and Metabolic MedicineUniversity of LeedsLeedsUK
| | - Lauren Coles
- Multidisciplinary Cardiovascular Research Centre and Biomedical Imaging Science DepartmentLeeds Institute of Cardiovascular and Metabolic MedicineUniversity of LeedsLeedsUK
| | - Charles Bowers
- Multidisciplinary Cardiovascular Research Centre and Biomedical Imaging Science DepartmentLeeds Institute of Cardiovascular and Metabolic MedicineUniversity of LeedsLeedsUK
| | - Anshuman Sengupta
- Multidisciplinary Cardiovascular Research Centre and Biomedical Imaging Science DepartmentLeeds Institute of Cardiovascular and Metabolic MedicineUniversity of LeedsLeedsUK
| | - Peter Swoboda
- Multidisciplinary Cardiovascular Research Centre and Biomedical Imaging Science DepartmentLeeds Institute of Cardiovascular and Metabolic MedicineUniversity of LeedsLeedsUK
| | - Klaus Witte
- Discovery and Translational Science DepartmentLeeds Institute of Cardiovascular and Metabolic MedicineUniversity of LeedsLeedsUK
| | - Richard Cubbon
- Discovery and Translational Science DepartmentLeeds Institute of Cardiovascular and Metabolic MedicineUniversity of LeedsLeedsUK
| | - Hui Xue
- National Heart, Lung, and Blood InstituteNational Institutes of HealthDepartment of Health and Human ServicesBethesdaMarylandUSA
| | - Peter Kellman
- National Heart, Lung, and Blood InstituteNational Institutes of HealthDepartment of Health and Human ServicesBethesdaMarylandUSA
| | - John Greenwood
- Multidisciplinary Cardiovascular Research Centre and Biomedical Imaging Science DepartmentLeeds Institute of Cardiovascular and Metabolic MedicineUniversity of LeedsLeedsUK
| | - Sven Plein
- Multidisciplinary Cardiovascular Research Centre and Biomedical Imaging Science DepartmentLeeds Institute of Cardiovascular and Metabolic MedicineUniversity of LeedsLeedsUK
| | - Eylem Levelt
- Multidisciplinary Cardiovascular Research Centre and Biomedical Imaging Science DepartmentLeeds Institute of Cardiovascular and Metabolic MedicineUniversity of LeedsLeedsUK
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22
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Multiparametric CMR imaging of myocardial structure and function changes in diabetic mini-pigs with preserved LV function: a preliminary study. BMC Cardiovasc Disord 2022; 22:143. [PMID: 35366800 PMCID: PMC8976391 DOI: 10.1186/s12872-022-02597-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 03/29/2022] [Indexed: 11/10/2022] Open
Abstract
Background The purpose of this study is to dynamically monitor the myocardial structure and function changes in diabetic mini-pigs by 1.5 T cardiac magnetic resonance. Methods Three male mini-pigs underwent cardiac magnet resonance (CMR) imaging, and histologic examination. T1-mapping was acquired at basal, mid and apical segments. CMR feature-tracking (CMR-FT) is used to quantify left ventricle global longitudinal (LVGLS), circumferential (LVGCS) and radial strain (LVGRS). Epicardial adipose tissue (EAT) was evaluated using a commercially available software. Results Left ventricular mass (LVM), myocardial native T1 value, extracellular volume (ECV) value and EAT were increased gradually after 6 months of modeling, while LVGLS decreased gradually after 6 months of modeling (LVM: 24.5 (23.4, 26.7) vs. 42.7 (41.4, 44.6) g/m2, p < 0.001; Native T1: 1005.5 (992.6, 1010.7) vs. 1028.7 (1015.5, 1035.6) ms, p = 0.041; EAT: 16.1 (14.5, 18.2) vs. 24.6 (20.8, 26.9) mL, p = 0.020; ECV: 21.4 (20.2, 23.9) vs. 28.9 (26.7, 30.3) %, p = 0.011; LVGLS: − 22.8 (− 21.4, − 23.9) vs. − 17.4 (− 17.2, − 19.2)%, p = 0.008). The diffuse myocardial interstitial fibrosis was found in histology samples. Conclusion The progressive impairments in LV structure and myocardial deformation occurs in diabetic mini-pigs. T1 mapping and CMR-FT technology are promising to monitor abnormal changes of diabetic myocardium in the early stage of diabetic cardiomyopathy.
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23
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Marwick TH, Gimelli A, Plein S, Bax JJ, Charron P, Delgado V, Donal E, Lancellotti P, Levelt E, Maurovich-Horvat P, Neubauer S, Pontone G, Saraste A, Cosyns B, Edvardsen T, Popescu BA, Galderisi M, Derumeaux G, Bäck M, Bertrand PB, Dweck M, Keenan N, Magne J, Neglia D, Stankovic I. Multimodality imaging approach to left ventricular dysfunction in diabetes: an expert consensus document from the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging 2022; 23:e62-e84. [PMID: 34739054 DOI: 10.1093/ehjci/jeab220] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 10/05/2021] [Indexed: 01/14/2023] Open
Abstract
Heart failure (HF) is among the most important and frequent complications of diabetes mellitus (DM). The detection of subclinical dysfunction is a marker of HF risk and presents a potential target for reducing incident HF in DM. Left ventricular (LV) dysfunction secondary to DM is heterogeneous, with phenotypes including predominantly systolic, predominantly diastolic, and mixed dysfunction. Indeed, the pathogenesis of HF in this setting is heterogeneous. Effective management of this problem will require detailed phenotyping of the contributions of fibrosis, microcirculatory disturbance, abnormal metabolism, and sympathetic innervation, among other mechanisms. For this reason, an imaging strategy for the detection of HF risk needs to not only detect subclinical LV dysfunction (LVD) but also characterize its pathogenesis. At present, it is possible to identify individuals with DM at increased risk HF, and there is evidence that cardioprotection may be of benefit. However, there is insufficient justification for HF screening, because we need stronger evidence of the links between the detection of LVD, treatment, and improved outcome. This review discusses the options for screening for LVD, the potential means of identifying the underlying mechanisms, and the pathways to treatment.
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Affiliation(s)
- Thomas H Marwick
- Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, VIC 3004, Australia
| | - Alessia Gimelli
- Fondazione Toscana Gabriele Monasterio, Via Moruzzi, 1, 56124 Pisa, Italy
| | - Sven Plein
- Multidisciplinary Cardiovascular Research Center & Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Centre (LUMC), Leiden, The Netherlands
| | - Phillippe Charron
- Sorbonne Université, INSERM UMRS 1166 and ICAN Institute, Paris, France
- APHP, Centre de référence pour les maladies cardiaques héréditaires ou rares, Hôpital Pitié-Salpêtrière, Paris, France
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Centre, Albinusdreef 2, Leiden 2300RC, The Netherlands
| | - Erwan Donal
- Service de Cardiologie Et Maladies Vasculaires Et CIC-IT 1414, CHU Rennes, 35000 Rennes, France
- Université de Rennes 1, LTSI, 35000 Rennes, France
| | - Patrizio Lancellotti
- Department of Cardiology, University of Liège Hospital, GIGA Cardiovascular Sciences, CHU SartTilman, Liège, Belgium
- Gruppo Villa Maria Care and Research, Maria Cecilia Hospital, Cotignola, and Anthea Hospital, Bari, Italy
| | - Eylem Levelt
- Department of Cardiovascular Sciences, University of Leicester, Glenfield Hospital , Groby Road, Leicester LE3 9QF, UK
| | - Pal Maurovich-Horvat
- MTA-SE Cardiovascular Imaging Research Group, Medical Imaging Centre, Semmelweis University, 2 Koranyi u., 1083 Budapest, Hungary
| | - Stefan Neubauer
- Radcliffe Department of Medicine, University of Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, Headley Way, Oxford OX3 9DU, UK
| | - Gianluca Pontone
- Centro Cardiologico Monzino IRCCS, University of Milan, Cardiovascular Imaging, Milan, Italy
| | - Antti Saraste
- Turku PET Centre, University of Turku, Turku, Finland
- Heart Center, Turku University Hospital, Turku, Finland
| | - Bernard Cosyns
- Cardiology, CHVZ (Centrum voor Hart en Vaatziekten), ICMI (In Vivo Cellular and Molecular Imaging) Laboratory, Universitair ziekenhuis Brussel, 109 Laarbeeklaan, Brussels 1090, Belgium
| | - Thor Edvardsen
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, Postbox 4950 Nydalen, Sognsvannsveien 20, NO-0424 Oslo, Norway
- Institute for clinical medicine, University of Oslo, Sognsvannsveien 20, NO-0424 Oslo, Norway
| | - Bogdan A Popescu
- Department of Cardiology, University of Medicine and Pharmacy "Carol Davila", Euroecolab, Emergency Institute for Cardiovascular Diseases "Prof. Dr. C. C. Iliescu", Bucharest, Romania
| | - Maurizio Galderisi
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Genevieve Derumeaux
- IMRB - Inserm U955 Senescence, metabolism and cardiovascular diseases 8, rue du Général Sarrail, 94010 Créteil, France
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24
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Jürgens M, Schou M, Hasbak P, Kjær A, Wolsk E, Zerahn B, Wiberg M, Brandt-Jacobsen NH, Gæde P, Rossing P, Faber J, Inzucchi SE, Gustafsson F, Kistorp C. Effects of Empagliflozin on Myocardial Flow Reserve in Patients With Type 2 Diabetes Mellitus: The SIMPLE Trial. J Am Heart Assoc 2021; 10:e020418. [PMID: 34278803 PMCID: PMC8475664 DOI: 10.1161/jaha.120.020418] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background Sodium–glucose cotransporter 2 inhibitors reduce hospitalizations for heart failure and cardiovascular death, although the underlying mechanisms have not been resolved. The SIMPLE trial (The Effects of Empagliflozin on Myocardial Flow Reserve in Patients With Type 2 Diabetes Mellitus) investigated the effects of empagliflozin on myocardial flow reserve (MFR) reflecting microvascular perfusion, in patients with type 2 diabetes mellitus at high cardiovascular disease risk. Methods and Results We randomized 90 patients to either empagliflozin 25 mg once daily or placebo for 13 weeks, as add‐on to standard therapy. The primary outcome was change in MFR at week 13, quantified by Rubidium‐82 positron emission tomography/computed tomography. The secondary key outcomes were changes in resting rate‐pressure product adjusted MFR, changes to myocardial flow during rest and stress, and reversible cardiac ischemia. Mean baseline MFR was 2.21 (95% CI, 2.08–2.35). There was no change from baseline in MFR at week 13 in either the empagliflozin: 0.01 (95% CI, −0.18 to 0.21) or placebo groups: 0.06 (95% CI, −0.15 to 0.27), with no treatment effect −0.05 (95% CI, −0.33 to 0.23). No effects on the secondary outcome parameters by Rubidium‐82 positron emission tomography/computed tomography was observed. Treatment with empagliflozin reduced hemoglobin A1c by 0.76% (95% CI, 1.0–0.5; P<0.001) and increased hematocrit by 1.69% (95% CI, 0.7–2.6; P<0.001). Conclusions Empagliflozin did not improve MFR among patients with type 2 diabetes mellitus and high cardiovascular disease risk. The present study does not support that short‐term improvement in MFR explains the reduction in cardiovascular events observed in the outcome trials. Registration URL: https://clinicaltrialsregister.eu/; Unique identifier: 2016‐003743‐10.
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Affiliation(s)
- Mikkel Jürgens
- Department of Endocrinology Rigshospitalet Copenhagen University Hospital Copenhagen Denmark.,Department of Endocrinology Copenhagen University HospitalHerlev/Gentofte Herlev Denmark
| | - Morten Schou
- Department of Cardiology Copenhagen University Hospitals Herlev/Gentofte Herlev Denmark.,Department of Clinical Medicine Faculty of Health and Medical Sciences University of Copenhagen Copenhagen Denmark
| | - Philip Hasbak
- Department of Clinical Physiology Nuclear Medicine & PET and Cluster for Molecular Imaging Department of Biomedical Sciences Rigshospitalet and University of Copenhagen Copenhagen Denmark
| | - Andreas Kjær
- Department of Clinical Physiology Nuclear Medicine & PET and Cluster for Molecular Imaging Department of Biomedical Sciences Rigshospitalet and University of Copenhagen Copenhagen Denmark
| | - Emil Wolsk
- Department of Cardiology The Heart CentreRigshospitalet Copenhagen University Hospital Copenhagen Denmark
| | - Bo Zerahn
- Department of Clinical Physiology and Nuclear Medicine Copenhagen University Hospitals Herlev/Gentofte Herlev Denmark
| | - Mikkel Wiberg
- Department of Endocrinology Rigshospitalet Copenhagen University Hospital Copenhagen Denmark
| | - Niels H Brandt-Jacobsen
- Department of Endocrinology Rigshospitalet Copenhagen University Hospital Copenhagen Denmark
| | - Peter Gæde
- Slagelse Hospital Slagelse Denmark.,University of Southern Denmark Odense Denmark
| | - Peter Rossing
- Department of Clinical Medicine Faculty of Health and Medical Sciences University of Copenhagen Copenhagen Denmark.,Steno Diabetes Center Copenhagen Gentofte Denmark
| | - Jens Faber
- Department of Endocrinology Copenhagen University HospitalHerlev/Gentofte Herlev Denmark.,Department of Clinical Medicine Faculty of Health and Medical Sciences University of Copenhagen Copenhagen Denmark
| | - Silvio E Inzucchi
- Yale Section of EndocrinologyYale University School of Medicine New Haven CT
| | - Finn Gustafsson
- Department of Cardiology The Heart CentreRigshospitalet Copenhagen University Hospital Copenhagen Denmark
| | - Caroline Kistorp
- Department of Endocrinology Rigshospitalet Copenhagen University Hospital Copenhagen Denmark.,Department of Clinical Medicine Faculty of Health and Medical Sciences University of Copenhagen Copenhagen Denmark
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25
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Noh RM, Graveling AJ, Lang NN, White AC, Lee KK, Mills NL, Newby DE, Lang CC, Frier BM. Effect of hypoglycaemia on measures of myocardial blood flow and myocardial injury in adults with and without type 1 diabetes: A prospective, randomised, open-label, blinded endpoint, cross-over study. Endocrinol Diabetes Metab 2021; 4:e00258. [PMID: 34277982 PMCID: PMC8279606 DOI: 10.1002/edm2.258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 04/04/2021] [Accepted: 04/17/2021] [Indexed: 11/15/2022] Open
Abstract
AIMS This study examined the effect of experimentally-induced hypoglycaemia on measures of myocardial blood flow and myocardial injury in adults with, and without, type 1 diabetes. METHODS In a prospective, randomised, open-label, blinded, endpoint cross-over study, 17 young adults with type 1 diabetes with no cardiovascular risk factors, and 10 healthy non-diabetic volunteers, underwent hyperinsulinaemic-euglycaemic (blood glucose 4.5-5.5 mmol/L) and hypoglycaemic (2.2-2.5 mmol/L) clamps. Myocardial blood flow was assessed using transthoracic echocardiography Doppler coronary flow reserve (CFR) and myocardial injury using plasma high-sensitivity cardiac troponin I (hs-cTnI) concentration. RESULTS During hypoglycaemia, coronary flow reserve trended non-significantly lower in those with type 1 diabetes than in the non-diabetic participants (3.54 ± 0.47 vs. 3.89 ± 0.89). A generalised linear mixed-model analysis examined diabetes status and euglycaemia or hypoglycaemia as factors affecting CFR. No statistically significant difference in CFR was observed for diabetes status (p = .23) or between euglycaemia and hypoglycaemia (p = .31). No changes in hs-cTnI occurred during hypoglycaemia or in the recovery period (p = .86). CONCLUSIONS A small change in CFR was not statistically significant in this study, implying hypoglycaemia may require more than coronary vasomotor dysfunction to cause harm. Further larger studies are required to investigate this putative problem.
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Affiliation(s)
- Radzi M. Noh
- Department of DiabetesRoyal Infirmary of EdinburghEdinburghUK
| | | | - Ninian N. Lang
- Centre for Cardiovascular ScienceUniversity of EdinburghEdinburghUK
| | - Audrey C. White
- Centre for Cardiovascular ScienceUniversity of EdinburghEdinburghUK
| | - Kuan K. Lee
- Centre for Cardiovascular ScienceUniversity of EdinburghEdinburghUK
| | | | - David E. Newby
- Centre for Cardiovascular ScienceUniversity of EdinburghEdinburghUK
| | - Chim C. Lang
- Division of Molecular and Clinical MedicineUniversity of DundeeDundeeUK
| | - Brian M. Frier
- Department of DiabetesRoyal Infirmary of EdinburghEdinburghUK
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26
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Rasmussen IKB, Hasbak P, von Scholten BJ, Laursen JC, Zobel EH, Jorge Diaz L, Holmvang L, Ripa RS, Rossing P, Kjaer A, Hansen TW. Non-invasive assessment of temporal changes in myocardial microvascular function in persons with type 2 diabetes and healthy controls. Diabet Med 2021; 38:e14517. [PMID: 33434331 PMCID: PMC8248340 DOI: 10.1111/dme.14517] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 01/06/2021] [Accepted: 01/07/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Cardiac Rubidium-82 (82 Rb) positron emission tomography/computed tomography (PET/CT) provides a measure of the myocardial blood flow and the myocardial flow reserve, which reflects the function of both large epicardial arteries and the myocardial microcirculation. Knowledge on changes in the myocardial microvascular function over time is lacking. METHODS In this cohort study, we recruited 60 persons with type 2 diabetes and 30 non-diabetic controls, in 2013; all free of overt cardiovascular disease. All underwent a cardiac 82 Rb PET/CT scan. In 2019, all survivors (n = 82) were invited for a repeated cardiac 82 Rb PET/CT scan using the same protocol, and 29 with type 2 diabetes and 19 controls participated. RESULTS Median duration between visits was 6.2 years (IQR: 6.1-6.3). In the total cohort, the mean age was 66.4 years (SD: 9.3) and 33% were females. The myocardial flow reserve was lower in persons with type 2 diabetes compared to controls (p = 0.002) but there was no temporal change in the myocardial flow reserve in participants with type 2 diabetes: mean change: -0.22 (95% CI: -0.47 to 0.02) nor in controls: -0.12 (-0.49 to 0.25) or when comparing type 2 diabetes to controls: mean difference: -0.10 (95% CI: -0.52 to 0.31). The temporal reduction in stress-induced myocardial blood flow did not differ within the groups but was more pronounced in type 2 diabetes compared to controls: mean difference: -0.30 (95% CI: -0.55 to -0.04). CONCLUSION The myocardial microvascular function was impaired in persons with type 2 diabetes compared to controls but did not change significantly in either of the groups when evaluated over 6 years.
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Affiliation(s)
| | - Philip Hasbak
- Department of Clinical PhysiologyNuclear Medicine & PET and Cluster for Molecular ImagingRigshospitaletDenmark
| | | | | | | | | | | | - Rasmus S. Ripa
- Department of Clinical PhysiologyNuclear Medicine & PET and Cluster for Molecular ImagingRigshospitaletDenmark
| | - Peter Rossing
- Steno Diabetes Center CopenhagenCopenhagenDenmark
- University of CopenhagenCopenhagenDenmark
| | - Andreas Kjaer
- Department of Clinical PhysiologyNuclear Medicine & PET and Cluster for Molecular ImagingRigshospitaletDenmark
- University of CopenhagenCopenhagenDenmark
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27
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Bilak JM, Gulsin GS, McCann GP. Cardiovascular and systemic determinants of exercise capacity in people with type 2 diabetes mellitus. Ther Adv Endocrinol Metab 2021; 12:2042018820980235. [PMID: 33552463 PMCID: PMC7844448 DOI: 10.1177/2042018820980235] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 11/20/2020] [Indexed: 12/15/2022] Open
Abstract
The global burden of heart failure (HF) is on the rise owing to an increasing incidence of lifestyle related diseases, predominantly type 2 diabetes mellitus (T2D). Diabetes is an independent risk factor for cardiovascular disease, and up to 75% of those with T2D develop HF in their lifetime. T2D leads to pathological alterations within the cardiovascular system, which can progress insidiously and asymptomatically in the absence of conventional risk factors. Reduced exercise tolerance is consistently reported, even in otherwise asymptomatic individuals with T2D, and is the first sign of a failing heart. Because aggressive modification of cardiovascular risk factors does not eliminate the risk of HF in T2D, it is likely that other factors play a role in the pathogenesis of HF. Early identification of individuals at risk of HF is advantageous, as it allows for modification of the reversible risk factors and early initiation of treatment with the aim of improving clinical outcomes. In this review, cardiac and extra-cardiac contributors to reduced exercise tolerance in people with T2D are explored.
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Affiliation(s)
- Joanna M. Bilak
- Department of Cardiovascular Sciences, University of Leicester and The National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, Leicester, UK
| | - Gaurav S. Gulsin
- Department of Cardiovascular Sciences, University of Leicester and The National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, Leicester, UK
| | - Gerry P. McCann
- Department of Cardiovascular Sciences, University of Leicester, Glenfield Hospital, Groby Road, Leicester LE39QP, UK
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28
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Horton WB, Jahn LA, Hartline LM, Aylor KW, Patrie JT, Barrett EJ. Acute hyperglycaemia enhances both vascular endothelial function and cardiac and skeletal muscle microvascular function in healthy humans. J Physiol 2021; 600:949-962. [PMID: 33481251 DOI: 10.1113/jp281286] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 01/15/2021] [Indexed: 12/30/2022] Open
Abstract
KEY POINTS Multiple clinical studies report that acute hyperglycaemia (induced by mixed meal or oral glucose) decreases arterial vascular function in healthy humans. Feeding, however, impacts autonomic output, blood pressure, and insulin and incretin secretion, which may themselves alter vascular function. No prior studies have examined the effect of acute hyperglycaemia on both macro- and microvascular function while controlling plasma insulin concentrations. Macrovascular and microvascular functional responses to euglycaemia and hyperglycaemia were compared. Octreotide was infused throughout both protocols to prevent endogenous insulin release. Acute hyperglycaemia (induced by intravenous glucose) enhanced brachial artery flow-mediated dilatation, increased skeletal muscle microvascular blood volume and flow, and expanded cardiac muscle microvascular blood volume. Compared to other published findings, the results suggest that vascular responses to acute hyperglycaemia differ based on the study population (i.e. normal weight vs. overweight/obese) and/or glucose delivery method (i.e. intravenous vs. oral glucose). ABSTRACT High glucose concentrations acutely provoke endothelial cell oxidative stress and are suggested to trigger diabetes-related macro- and microvascular injury in humans. Multiple clinical studies report that acute hyperglycaemia (induced by mixed meal or oral glucose) decreases arterial vascular function in healthy humans. Feeding, however, impacts autonomic output, blood pressure, and insulin and incretin secretion, which may each independently alter vascular function and obscure the effect of acute hyperglycaemia per se. Surprisingly, no studies have examined the acute effects of intravenous glucose-induced hyperglycaemia on both macro- and microvascular function while controlling plasma insulin concentrations. In this randomized study of healthy young adults, we compared macrovascular (i.e. brachial artery flow-mediated dilatation, carotid-femoral pulse wave velocity and post-ischaemic brachial artery flow velocity) and microvascular (heart and skeletal muscle perfusion by contrast-enhanced ultrasound) functional responses to euglycaemia and hyperglycaemia. Octreotide was infused throughout both protocols to prevent endogenous insulin release. Acute intravenous glucose-induced hyperglycaemia enhanced brachial artery flow-mediated dilatation (P = 0.004), increased skeletal muscle microvascular blood volume and flow (P = 0.001), and expanded cardiac muscle microvascular blood volume (P = 0.014). No measure of vascular function changed during octreotide-maintained euglycaemia. Our findings suggest that unlike meal-provoked acute hyperglycaemia, 4 h of intravenous glucose-induced hyperglycaemia enhances brachial artery flow-mediated dilatation, provokes cardiac and skeletal muscle microvascular function, and does not impair aortic stiffness. Previous findings of acute large artery vascular dysfunction during oral glucose or mixed meal ingestion may be due to differences in study populations and meal-induced humoral or neural factors beyond hyperglycaemia per se. (ClinicalTrials.gov number NCT03520569.).
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Affiliation(s)
- William B Horton
- Division of Endocrinology and Metabolism, Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Linda A Jahn
- Division of Endocrinology and Metabolism, Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Lee M Hartline
- Division of Endocrinology and Metabolism, Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Kevin W Aylor
- Division of Endocrinology and Metabolism, Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - James T Patrie
- Division of Biostatistics, Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Eugene J Barrett
- Division of Endocrinology and Metabolism, Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA, USA.,Department of Pharmacology, University of Virginia School of Medicine, Charlottesville, VA, USA
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29
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Sørensen MH, Bojer AS, Jørgensen NR, Broadbent DA, Plein S, Madsen PL, Gæde P. Fibroblast growth factor-23 is associated with imaging markers of diabetic cardiomyopathy and anti-diabetic therapeutics. Cardiovasc Diabetol 2020; 19:158. [PMID: 32998751 PMCID: PMC7528463 DOI: 10.1186/s12933-020-01135-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 09/23/2020] [Indexed: 01/08/2023] Open
Abstract
Background The biomarker fibroblast growth factor-23 (FGF-23) has been associated with increased cardiovascular morbidity and mortality in both patients with and without type 2 diabetes. The aim of this study was to evaluate the relationship between FGF-23 and cardiac structure, function and perfusion in patients with type 2 diabetes and normal or mildly impaired kidney function. Furthermore, to investigate the association between FGF-23, anti-diabetes therapy and the classic complications and risk factors associated with type 2 diabetes. Methods In this cross-sectional study, 246 patients with type 2 diabetes underwent echocardiography and advanced cardiac magnetic resonance imaging to assess left ventricular (LV) structure and function. In addition, myocardial blood flow (MBF) during rest and pharmacological stress (adenosine 140 µg/kg/min) were evaluated in 183 of the patients. Patients with eGFR < 60 ml/min/1.73 m2 were excluded. Results Median (Q1–Q3) FGF-23 was 74 (58–91) ng/L. Patients with FGF-23 above the median had lower MBF during stress (2.3 ± 0.9 vs. 2.7 ± 0.9 ml/min/g, P = 0.001) and lower overall myocardial perfusion reserve (MPR) (2.7 ± 0.8 vs. 3.3 ± 1.1, P < 0.001). LV mass (143 ± 40 vs. 138 ± 36 g, P = 0.04) and E/e* (8.5 ± 3.2 vs. 7.6 ± 2.7, P = 0.04) were higher in patients with FGF-23 above the median. In a linear model adjusted for age, sex, eGFR and hypertension, increasing FGF-23 was associated with decreased MPR (P < 0.01, R2 = 0.11) and increased E/e* (P < 0.01, R2 = 0.07). FGF-23 was lower in patients receiving glucagon like peptide-1 (GLP-1) analogues (71 (57–86) vs. 80 (60–98) ng/L, P = 0.01) than in those who did not receive GLP-1 analogues. Conclusions In patients with type 2 diabetes and normal or mildly impaired kidney function, increased levels of FGF-23 are associated with impaired cardiac diastolic function and decreased MPR, caused by a decrease in maximal MBF during stress. Use of GLP-1 analogues is associated with decreased levels of FGF-23. Clinical trial registrationhttps://www.clinicaltrials.gov. Unique identifier: NCT02684331. Date of registration: February 18, 2016
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Affiliation(s)
- Martin H Sørensen
- Department of Cardiology and Endocrinology, Slagelse Hospital, Ingemannsvej 32, 4200, Slagelse, Region Zealand, Denmark. .,Institute of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.
| | - Annemie S Bojer
- Department of Cardiology and Endocrinology, Slagelse Hospital, Ingemannsvej 32, 4200, Slagelse, Region Zealand, Denmark.,Institute of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Niklas R Jørgensen
- Department of Clinical Biochemistry, Rigshospitalet, Glostrup, Capital Region of Denmark, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - David A Broadbent
- Department of Medical Physics and Engineering, Leeds Teaching Hospitals NHS Trust, Leeds, UK.,Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Sven Plein
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Per L Madsen
- Department of Cardiology, Copenhagen University Hospital Herlev-Gentofte, Hellerup, Capital Region of Denmark, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Peter Gæde
- Department of Cardiology and Endocrinology, Slagelse Hospital, Ingemannsvej 32, 4200, Slagelse, Region Zealand, Denmark.,Institute of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
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30
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Li XM, Jiang L, Guo YK, Ren Y, Han PL, Peng LQ, Shi R, Yan WF, Yang ZG. The additive effects of type 2 diabetes mellitus on left ventricular deformation and myocardial perfusion in essential hypertension: a 3.0 T cardiac magnetic resonance study. Cardiovasc Diabetol 2020; 19:161. [PMID: 32998742 PMCID: PMC7528579 DOI: 10.1186/s12933-020-01138-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Accepted: 09/23/2020] [Indexed: 02/05/2023] Open
Abstract
Background Type 2 diabetes mellitus (T2DM) increases the risks of heart failure and mortality in patients with hypertension, however the underlying mechanism is unclear. This study aims to investigate the impact of coexisting T2DM on left ventricular (LV) deformation and myocardial perfusion in hypertensive individuals. Materials and methods Seventy hypertensive patients without T2DM [HTN(T2DM−)], forty patients with T2DM [HTN(T2DM+)] and 37 age- and sex-matched controls underwent cardiac magnetic resonance examination. Left ventricular (LV) myocardial strains, including global radial (GRPS), circumferential (GCPS) and longitudinal peak strain (GLPS), and resting myocardial perfusion indices, including upslope, time to maximum signal intensity (TTM), and max signal intensity (MaxSI), were measured and compared among groups by analysis of covariance after adjusting for age, sex, body mass index (BMI) and heart rate followed by Bonferroni’s post hoc test. Backwards stepwise multivariable linear regression analyses were performed to determine the effects of T2DM on LV strains and myocardial perfusion indices in patients with hypertension. Results Both GRPS and GLPS deteriorated significantly from controls, through HTN(T2DM−), to HTN(T2DM+) group; GCPS in HTN(T2DM+) group was lower than those in both HTN(T2DM−) and control groups. Compared with controls, HTN(T2DM−) group showed higher myocardial perfusion, and HTN(T2DM+) group exhibited lower perfusion than HTN(T2DM−) group and controls. Multiple regression analyses considering covariates of systolic blood pressure, age, sex, BMI, heart rate, smoking, indexed LV mass and eGFR demonstrated that T2DM was independently associated with LV strains (GRPS: p = 0.002, model R2= 0.383; GCPS: p < 0.001, model R2= 0.472; and GLPS: p = 0.002, model R2= 0.424, respectively) and perfusion indices (upslope: p < 0.001, model R2= 0.293; TTM: p < 0.001, model R2= 0.299; and MaxSI: p < 0.001, model R2= 0.268, respectively) in hypertension. When both T2DM and perfusion indices were included in the regression analyses, both T2DM and TTM were independently associated with GRPS (p = 0.044 and 0.017, model R2= 0.390) and GCPS (p = 0.002 and 0.001, model R2= 0.424), and T2DM but not perfusion indices was independently associated with GLPS (p = 0.002, model R2= 0.424). Conclusion In patients with hypertension, T2DM had an additive deleterious effect on subclinical LV systolic dysfunction and myocardial perfusion, and impaired myocardial perfusion by coexisting T2DM was associated with deteriorated LV systolic dysfunction.
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Affiliation(s)
- Xue-Ming Li
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, People's Republic of China.,Department of Radiology, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, 55# Lan 4 RenMing Road (South), Chengdu, 610041, Sichuan, People's Republic of China
| | - Li Jiang
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, People's Republic of China
| | - Ying-Kun Guo
- Department of Radiology, Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, West China Second University Hospital, Sichuan University, 20# South Renmin Road, Chengdu, 610041, Sichuan, People's Republic of China
| | - Yan Ren
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, People's Republic of China
| | - Pei-Lun Han
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, People's Republic of China
| | - Li-Qing Peng
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, People's Republic of China
| | - Rui Shi
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, People's Republic of China
| | - Wei-Feng Yan
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, People's Republic of China
| | - Zhi-Gang Yang
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, People's Republic of China.
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