Duce Suzanne L, Weir-McCall Jonathan R, Gandy Stephen J, Matthew Shona Z, Cassidy Deirdre B, McCormick Lynne, Rauchhaus Petra, Looker Helen, Colhoun Helen M, Houston J Graeme
Division of Cardiovascular and Diabetes Medicine, Medical Research Institute, University of Dundee, Level 7, Ninewells Hospital, Dundee, DD1 9SY, UK.
NHS Tayside Clinical Radiology, Ninewells Hospital, Dundee, DD1 9SY, UK.
Cardiovasc Diabetol. 2015 Sep 18;14:122. doi: 10.1186/s12933-015-0284-2.
Whole body cardiovascular MR (WB CVMR) combines whole body angiography and cardiac MR assessment. It is accepted that there is a high disease burden in patients with diabetes, however the quantification of the whole body atheroma burden in both arterial and cardiac disease has not been previously reported. In this study we compare the quantified atheroma burden in those individuals with and without diabetes by clinical cardiovascular disease (CVD) status.
158 participants underwent WB CVMR, and were categorised into one of four groups: (1) type 2 diabetes mellitus (T2DM) with CVD; (2) T2DM without CVD; (3) CVD without T2DM; (4) healthy controls. The arterial tree was subdivided into 31 segments and each scored according to the degree of stenosis. From this a standardised atheroma score (SAS) was calculated. Cardiac MR and late gadolinium enhancement images of the left ventricle were obtained for assessment of mass, volume and myocardial scar assessment.
148 participants completed the study protocol--61% male, with mean age of 64 ± 8.2 years. SAS was highest in those with cardiovascular disease without diabetes [10.1 (0-39.5)], followed by those with T2DM and CVD [4 (0-41.1)], then those with T2DM only [3.23 (0-19.4)] with healthy controls having the lowest atheroma score [2.4 (0-19.4)]. Both groups with a prior history of CVD had a higher SAS and left ventricular mass than those without (p < 0.001 for both). However after accounting for known cardiovascular risk factors, only the SAS in the group with CVD without T2DM remained significantly elevated. 6% of the T2DM group had evidence of silent myocardial infarct, with this subcohort having a higher SAS than the remainder of the T2DM group [7.7 (4-19) vs. 2.8 (0-17), p = 0.024].
Global atheroma burden was significantly higher in those with known cardiovascular disease and without diabetes but not in those with diabetes and cardiovascular disease suggesting that cardiovascular events may occur at a lower atheroma burden in diabetes.
全身心血管磁共振成像（WB CVMR）结合了全身血管造影和心脏磁共振评估。众所周知，糖尿病患者疾病负担较重，然而，此前尚未有关于动脉和心脏疾病中全身动脉粥样硬化负担定量的报道。在本研究中，我们根据临床心血管疾病（CVD）状态，比较了糖尿病患者和非糖尿病患者的动脉粥样硬化负担量化情况。
158名参与者接受了WB CVMR检查，并被分为四组之一：（1）患有CVD的2型糖尿病（T2DM）；（2）无CVD的T2DM；（3）无T2DM的CVD；（4）健康对照。将动脉树分为31段，并根据狭窄程度进行评分。据此计算标准化动脉粥样硬化评分（SAS）。获取心脏磁共振成像和左心室钆增强延迟图像，以评估心肌质量、容积和心肌瘢痕。
148名参与者完成了研究方案，其中男性占61%，平均年龄为64±8.2岁。无糖尿病的心血管疾病患者的SAS最高[10.1（0 - 39.5）]，其次是患有T2DM和CVD的患者[4（0 - 41.1）]，然后是仅患有T2DM的患者[3.23（0 - 19.4）]，健康对照的动脉粥样硬化评分最低[2.4（0 - 19.4）]。有CVD病史的两组患者的SAS和左心室质量均高于无CVD病史的患者（两者p均<0.001）。然而，在考虑已知的心血管危险因素后，只有无T2DM的CVD组的SAS仍显著升高。T2DM组中有6%的患者有隐匿性心肌梗死的证据，该亚组的SAS高于T2DM组的其余患者[7.7（4 - 19）对2.8（0 - 17），p = 0.024]。
已知患有心血管疾病且无糖尿病的患者的总体动脉粥样硬化负担显著更高，但糖尿病合并心血管疾病的患者并非如此，这表明糖尿病患者可能在较低的动脉粥样硬化负担水平下发生心血管事件。
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