The microvascular effects of insulin resistance and diabetes on cardiac structure, function, and perfusion: a cardiovascular magnetic resonance study

Abdulghani M Larghat, Peter P Swoboda, John D Biglands, Mark T Kearney, John P Greenwood, Sven Plein, Abdulghani M Larghat, Peter P Swoboda, John D Biglands, Mark T Kearney, John P Greenwood, Sven Plein

Abstract

Aims: Type 2 diabetes mellitus is an independent risk factor for the development of heart failure. To better understand the mechanism by which this occurs, we investigated cardiac structure, function, and perfusion in patients with and without diabetes.

Methods and results: Sixty-five patients with no stenosis >30% on invasive coronary angiography were categorized into diabetes (19) and non-diabetes (46) which was further categorized into prediabetes (30) and controls (16) according to the American Diabetes Association guidelines. Each patient underwent comprehensive cardiovascular magnetic resonance assessment. Left-ventricular (LV) mass, relative wall mass (RWM), Lagrangian circumferential strain, LV torsion, and myocardial perfusion reserve (MPR) were calculated. LV mass was higher in diabetics than non-diabetics (112.8 ± 39.7 vs. 91.5 ± 21.3 g, P = 0.01) and in diabetics than prediabetics (112.8 ± 39.7 vs. 90.3 ± 18.7 g, P = 0.02). LV torsion angle was higher in diabetics than non-diabetics (9.65 ± 1.90 vs. 8.59 ± 1.91°, P = 0.047), and MPR was lower in diabetics than non-diabetics (2.10 ± 0.76 vs. 2.84 ± 1.25 mL/g/min, P = 0.01). There was significant correlation between MPR and early diastolic strain rate (r = -0.310, P = 0.01) and LV torsion (r = -0.306, P = 0.01). In multivariable linear regression analysis, non-diabetics waist-hip ratio, but not body mass index, had a significant association with RWM (Beta = 0.34, P = 0.02).

Conclusion: Patients with diabetes have increased LV mass, LV torsion, and decreased MPR. There is a significant association between decreased MPR and increased LV torsion suggesting a possible mechanistic link between microvascular disease and cardiac dysfunction in diabetes.

Keywords: Cardiovascular magnetic resonance; Diabetes; Myocardial perfusion reserve; Prediabetes; Strain; Tagging.

© The Author 2014. Published by Oxford University Press on behalf of the European Society of Cardiology.

Figures

Figure 1:
Figure 1:
Mid-myocardial stress perfusion contours (top left) and blood flow after Fermi-constrained deconvolution (bottom left) with MBF (green) and AIF (red). Mid-myocardial CSPAMM tagging showing contours (top right) and Lagrangian circumferential strain over time (bottom right) with each colour representing a different layer: epicardium (blue), mid-myocardium (cyan), and endocardium (green)
Figure 2:
Figure 2:
Mean and 95% confidence intervals of LV mass, LVMI, and EF (top); LV twist, LV torsion, and circumferential strain (middle); and stress MBF, rest MBF, and MPR (below). Within each graph diabetes is on the left, prediabetes in the middle, and controls on the right

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