Cardiac magnetic resonance for asymptomatic patients with type 2 diabetes and cardiovascular high risk (CATCH): a pilot study

Ming-Yen Ng, Wenli Zhou, Varut Vardhanabhuti, Chi-Ho Lee, Esther Yee Tak Yu, Eric Yuk Fai Wan, Kit Chan, Andrew T Yan, Tai-Pang Ip, Kai-Hang Yiu, Bernd J Wintersperger, Ming-Yen Ng, Wenli Zhou, Varut Vardhanabhuti, Chi-Ho Lee, Esther Yee Tak Yu, Eric Yuk Fai Wan, Kit Chan, Andrew T Yan, Tai-Pang Ip, Kai-Hang Yiu, Bernd J Wintersperger

Abstract

Background: Stress cardiovascular magnetic resonance (CMR) to screen for silent myocardial ischaemia in asymptomatic high risk patients with type 2 diabetes mellitus (DM) has never been performed, and its effectiveness is unknown. Our aim was to determine the feasibility of a screening programme using stress CMR by obtaining preliminary data on the prevalence of silent ischaemia caused by obstructive coronary artery disease (CAD) and quantify myocardial perfusion in asymptomatic high risk patients with type 2 diabetes.

Methods: In this prospective cohort study, we recruited 63 asymptomatic DM patients (mean age 66 years ± 4.4 years; 77.8% male); with Framingham risk score ≥ 20% from 3 sites from June 2017 to August 2018. Normal volunteers were recruited to determine normal global myocardial perfusion reserve index (MPRI). Adenosine stress CMR and global MPRI was performed and measured in all subjects. Positive stress CMR cases were referred for catheter coronary angiography (CCA) with/without fractional flow reserve (FFR) measurements. Positive CCA was defined as an FFR ≤ 0.8 or coronary narrowing ≥ 70%. Patients were followed up for major adverse cardiovascular events. Prevalence is presented as patient numbers and percentage. Mann-Whitney U test was used to compare global MPRI between patients and normal volunteers.

Results: 13 patients had positive stress CMR with positive CCA (20.6% of patient population), while 9 patients with positive stress CMR examinations had a negative CCA. 5 patients (7.9%) had infarcts detected of which 2 patients had no stress perfusion defects. 12 patients had coronary artery stents inserted, whilst 1 patient declined stent placement. DM patients had lower global MPRI than normal volunteers (n = 7) (1.43 ± 0.27 vs 1.83 ± 0.31 respectively; p < 0.01). After a median follow-up of 653 days, there was no death, heart failure, acute coronary syndrome hospitalisation or stroke.

Conclusion: 20.6% of asymptomatic DM patients (with Framingham risk ≥ 20%) had silent obstructive CAD. Furthermore, asymptomatic patients have reduced global MPRI than normal volunteers.

Trial registration: ClinicalTrials.gov Registration Number: NCT03263728 on 28th August 2017; https://ichgcp.net/clinical-trials-registry/NCT03263728.

Keywords: Asymptomatic; High cardiovascular risk; Screening; Stress cardiac magnetic resonance; Type 2 diabetes.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
CONSORT diagram
Fig. 2
Fig. 2
Study design. CMR cardiac magnetic resonance, OMT optimised medical therapy, FFR fractional flow reserve
Fig. 3
Fig. 3
Asymptomatic male patient with type 2 diabetes mellitus who was actively hiking. This patient was recruited into our study and had a positive screening stress cardiac magnetic resonance. Top row of images show stress perfusion defects (red arrows) in the basal, mid-ventricular and apical slices in the left anterior descending (LAD) territory as well as a stress perfusion defect in the left circumflex (LCx) territory on the basal slice in the inferolateral wall (red arrow). These perfusion defects resolved on the rest images. The catheter coronary angiogram showed chronic total occlusion of the LAD (yellow arrow) and obstructive CAD of the LCx (yellow arrow). Fractional flow reserve measurements of the LCx was 0.69. Post-stenting image in the bottom right shows the re-perfusion of the LAD and expansion of the LCx narrowing

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