Possibilities of predicting preclinical forms of cardiovascular diseases in young patients with type 1 diabetes mellitus using cardiac magnetic resonance imaging

Aim. To identify the indicators of cardiac magnetic resonance (CMR), which have diagnostic value in the individual assessment of the cardiovascular prognosis in young patients with type 1 diabetes mellitus (T1DM).Material and Methods. The study included a total of 60 patients (29 men and 31 women) aged 18 to 36 years with a history of T1DM from 5 to 16 years, who underwent contrast-enhanced CMR. Circular strain, strain relaxation index (SRI), peak early diastolic strain rate (SRe), epicardial fat thickness (EFT), ejection fraction (EF), stroke volume (SV), end-diastolic volume (EDV), end-systolic volume (ESV), and left ventricular mass (LVM) were assessed. Echocardiography, 24-h electrocardiography (ECG), treadmill test, and NT-proBNP blood test were performed to exclude heart pathology. Statistical data processing was used to identify the relationships of changes in CMR parameters of the left ventricle and epicardial adipose tissue with disease duration, carbohydrate metabolism compensation (HbA1c), total cholesterol, and low-density lipoprotein (LDL).Results. Using the nonparametric Mann – Whitney U-test, the study showed the presence of significant differences in the values of SV, EDV, end-diastolic volume index (EDVI), and LVM in the groups of 5–10and 11–16-year duration of disease, respectively. The assessment of Spearman’s rank correlation coefficients revealed negative correlations between the values of SV, ESV, ESV index (ESVI), EDV, and LVM and T1DM duration; between the index of circular strain and blood level of HbA1c; between the values of SV, EDVI, ESVI, EDV, ESV, and LVM and blood levels of total cholesterol and LDL; between SV, EDVI, ESVI, EDV, ESV, and LVM and mean EFT in the left ventricular projection.Conclusion. The CMR-based evaluation of strain parameters may become a key in personalized identification of young T1DM patients with a high risk of adverse cardiovascular events. The thickness and distribution of epicardial adipose tissue in young patients with T1DM may have predictive value for risk stratification of developing diseases associated with atherosclerosis and chronic heart failure, which will affect the primary prevention strategy in this population.

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Epicardial Adipose Tissue and Outcome in Heart Failure With Mid-Range and Preserved Ejection Fraction

Circulation Heart Failure ◽

10.1161/circheartfailure.121.009238 ◽

2021 ◽

Author(s):

Gijs van Woerden ◽

Dirk J. van Veldhuisen ◽

Olivier C. Manintveld ◽

Vanessa P.M. van Empel ◽

Tineke P. Willems ◽

...

Keyword(s):

Heart Failure ◽

Adipose Tissue ◽

Cardiac Magnetic Resonance ◽

Magnetic Resonance ◽

Ejection Fraction ◽

Epicardial Adipose Tissue ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Preserved Ejection Fraction ◽

All Cause Mortality

Background: Epicardial adipose tissue (EAT) accumulation is thought to play a role in the pathophysiology of heart failure (HF) with mid-range and preserved ejection fraction, but its effect on outcome is unknown. We evaluated the prognostic value of EAT volume measured with cardiac magnetic resonance in patients with HF with mid-range ejection fraction and HF with preserved ejection fraction. Methods: Patients enrolled in a prospective multicenter study that investigated the value of implantable loop-recorders in HF with mid-range ejection fraction and HF with preserved ejection fraction were analyzed. EAT volume was quantified with cardiac magnetic resonance. Main outcome was the composite of all-cause mortality and first HF hospitalizations. Hazard ratios (HR) and 95% CI are described per SD increase in EAT. Results: We studied 105 patients (mean age 72±8 years, 50% women, and mean left ventricular ejection fraction 53±8%). During median follow-up of 24 (17–25) months, 31 patients (30%) died or were hospitalized for HF. In univariable analysis, EAT was significantly associated with a higher risk of the composite outcome (HR, 1.76 [95% CI, 1.24–2.50], P =0.001), and EAT remained associated with outcome after adjustment for age, sex, and body mass index (HR, 1.61 [95% CI, 1.13–2.31], P =0.009), and after adjustment for New York Heart Association functional class and N-terminal of pro-brain natriuretic peptide (HR, 1.53 [95% CI, 1.04–2.24], P =0.03). Furthermore, EAT was associated with all-cause mortality alone (HR, 2.06 [95% CI, 1.26–3.37], P =0.004) and HF hospitalizations alone (HR, 1.54 [95% CI, 1.04–2.30], P =0.03). Conclusions: EAT accumulation is associated with adverse prognosis in patients with HF with mid-range ejection fraction and HF with preserved ejection fraction. This finding supports the importance of EAT in these patients with HF. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT01989299.

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