Sharrack Noor, Brown Louise A E, Farley Jonathan, Wahab Ali, Jex Nicholas, Thirunavukarasu Sharmaine, Chowdhary Amrit, Gorecka Miroslawa, Javed Wasim, Xue Hui, Levelt Eylem, Dall'Armellina Erica, Kellman Peter, Garg Pankaj, Greenwood John P, Plein Sven, Swoboda Peter P
Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK.
National Heart, Lung and Blood Institute, Bethesda, Maryland, USA.
J Cardiovasc Magn Reson. 2024;26(2):101073. doi: 10.1016/j.jocmr.2024.101073. Epub 2024 Aug 2.
Patients with diabetes mellitus (DM) and heart failure (HF) have worse outcomes than normoglycemic HF patients. Cardiovascular magnetic resonance (CMR) can identify ischemic heart disease (IHD) and quantify coronary microvascular dysfunction (CMD) using myocardial perfusion reserve (MPR). We aimed to quantify the extent of silent IHD and CMD in patients with DM presenting with HF.
Prospectively recruited outpatients undergoing assessment into the etiology of HF underwent in-line quantitative perfusion CMR for calculation of stress and rest myocardial blood flow (MBF) and MPR. Exclusions included angina or history of IHD. Patients were followed up (median 3.0 years) for major adverse cardiovascular events (MACE).
Final analysis included 343 patients (176 normoglycemic, 84 with pre-diabetes, and 83 with DM). Prevalence of silent IHD was highest in DM 31% ( 26/83), then pre-diabetes 20% (17/84) then normoglycemia 17%, ( 30/176). Stress MBF was lowest in DM (1.53 ± 0.52), then pre-diabetes (1.59 ± 0.54) then normoglycemia (1.83 ± 0.62). MPR was lowest in DM (2.37 ± 0.85) then pre-diabetes (2.41 ± 0.88) then normoglycemia (2.61 ± 0.90). During follow-up, 45 patients experienced at least one MACE. On univariate Cox regression analysis, MPR and presence of silent IHD were both associated with MACE. However, after correction for HbA1c, age, and left ventricular ejection fraction, the associations were no longer significant.
Patients with DM and HF had higher prevalence of silent IHD, more evidence of CMD, and worse cardiovascular outcomes than their non-diabetic counterparts. These findings highlight the potential value of CMR for the assessment of silent IHD and CMD in patients with DM presenting with HF.
糖尿病（DM）合并心力衰竭（HF）患者的预后比血糖正常的HF患者更差。心血管磁共振成像（CMR）可以识别缺血性心脏病（IHD），并使用心肌灌注储备（MPR）对冠状动脉微血管功能障碍（CMD）进行量化。我们旨在量化伴有HF的DM患者中无症状IHD和CMD的程度。
前瞻性招募接受HF病因评估的门诊患者，进行在线定量灌注CMR，以计算应激和静息心肌血流量（MBF）以及MPR。排除标准包括心绞痛或IHD病史。对患者进行随访（中位时间3.0年），观察主要不良心血管事件（MACE）。
最终分析纳入343例患者（176例血糖正常，84例糖尿病前期，83例DM）。无症状IHD的患病率在DM中最高，为31%（26/83），其次是糖尿病前期为20%（17/84），血糖正常者为17%（30/176）。应激MBF在DM中最低（1.53±0.52），其次是糖尿病前期（1.59±0.54），血糖正常者（1.83±0.62）。MPR在DM中最低（2.37±0.85），其次是糖尿病前期（2.41±0.88），血糖正常者（2.61±0.90）。随访期间，45例患者发生至少一次MACE。单因素Cox回归分析显示，MPR和无症状IHD的存在均与MACE相关。然而，在校正糖化血红蛋白、年龄和左心室射血分数后，这些关联不再显著。
与非糖尿病患者相比，DM合并HF患者无症状IHD的患病率更高，CMD的证据更多，心血管结局更差。这些发现凸显了CMR在评估伴有HF的DM患者无症状IHD和CMD方面的潜在价值。
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