Department of Cardiology, University Hospital "Dr. Dragisa Misovic - Dedinje", Heroja Milana Tepica 1, 11000, Belgrade, Serbia.
University of Milan-Bicocca, Milan, Italy.
Acta Diabetol. 2020 Sep;57(9):1027-1034. doi: 10.1007/s00592-020-01528-2. Epub 2020 Apr 13.
Diabetes cardiomyopathy is a specific form of cardiac disease characteristic for diabetic patients. Development of echocardiography enabled diagnosis of diabetic cardiomyopathy significantly before the occurrence of heart failure. Previously was believed that left ventricular (LV) diastolic dysfunction represents the first detectable stage of diabetic cardiomyopathy. However, speckle tracking imaging and strain evaluation showed that mechanical changes occur before LV diastolic dysfunction. Nevertheless, it seems that the first detectable stage of diabetic cardiomyopathy is myocardial interstitial fibrosis, which currently could be diagnosed predominantly by cardiac magnetic resonance. T1 mapping evaluation before and after contrast injection enables assessment of extracellular volume (ECV) and provides qualitative and quantitative assessment of interstitial myocardial fibrosis in diabetic patients. Studies showed a strong correlation between ECV-parameter of interstitial fibrosis and level of glycated hemoglobin-main parameter of glucose control in diabetes. This stage of fibrosis is still not LV hypertrophy and it is reversible, which is of a great importance because of timely initiation of treatment. The necessity for early diagnose is significantly increasing due to the fact that diabetes and arterial hypertension are concomitant disorders in the large number of diabetic patients and it has been known that the risk of interstitial myocardial fibrosis is multiplied in patients with both conditions. Future follow-up investigations are essential to determine the causal relationship between interstitial fibrosis and outcome in these patients. The aim of this review was to summarize the current knowledge and clinical usefulness of CMR in diabetic patients.
糖尿病心肌病是一种特定形式的心脏疾病，特征为糖尿病患者。超声心动图的发展使得糖尿病心肌病的诊断能够在心力衰竭发生之前显著提前。以前认为左心室（LV）舒张功能障碍代表糖尿病心肌病的第一个可检测阶段。然而，斑点追踪成像和应变评估显示，机械变化发生在 LV 舒张功能障碍之前。尽管如此，糖尿病心肌病的第一个可检测阶段似乎是心肌间质纤维化，目前主要可以通过心脏磁共振诊断。对比剂注射前后 T1 映射评估可评估细胞外容积（ECV），并提供糖尿病患者间质心肌纤维化的定性和定量评估。研究表明，间质纤维化的 ECV 参数与糖化血红蛋白水平之间存在很强的相关性，糖化血红蛋白是糖尿病患者血糖控制的主要参数。该纤维化阶段仍然不是 LV 肥厚，而且是可逆转的，这非常重要，因为可以及时开始治疗。由于大量糖尿病患者同时患有糖尿病和动脉高血压，早期诊断的必要性显著增加，并且已知这两种情况下间质心肌纤维化的风险会增加。未来的随访研究对于确定这些患者间质纤维化与预后之间的因果关系至关重要。本文综述的目的是总结 CMR 在糖尿病患者中的现有知识和临床应用价值。
