Yang Wenjing, Zhu Leyi, Wu Weichun, Jiang Mengdi, Zhang Huaying, Zhou Di, Xu Jing, Wang Yining, Zhang Qiang, Sirajuddin Arlene, Arai Andrew E, Zhao Shihua, Lu Minjie
Departments of Magnetic Resonance Imaging, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Departments of Echocardiography, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
JACC Asia. 2024 Oct 22;4(12):940-952. doi: 10.1016/j.jacasi.2024.08.016. eCollection 2024 Dec.
Cardiac magnetic resonance imaging (CMR) could serve as a robust tool for comprehensive evaluation of early changes across heart failure (HF) stages classified by the American Heart Association/American College of Cardiology guideline in diabetes mellitus (DM).
The authors aimed to explore phenotypic imaging features characterizing DM participants at different HF stages by CMR.
DM participants with preserved ejection fraction who underwent CMR examination between January 2020 and December 2021 were evaluated. Left ventricular strain analysis and myocardial fibrosis was evaluated by CMR.
A total of four hundred seventy-five DM participants at different HF stages (mean age 56 ± 12 years; 326 men) and 78 healthy control subjects were evaluated. Significantly decreased absolute strain values with rising HF stage were identified in DM. In addition, early diastolic strain rates were significantly lower in stage B and C HF than in stage A HF and control subjects. Myocardial extracellular volume increased with advancing HF stage in DM (stage A, 27.0% ± 2.9%; stage B, 29.1% ± 3.5%; stage C, 30.5% ± 4.1%; < 0.05). In multivariable logistic regression analysis, early diastolic longitudinal strain rate (OR: 2.184; 95% CI: 1.378-3.461; 0.001) was a significant contributor that independently distinguished DM participants at stage A from control subjects, with an area under the receiver-operating characteristic curve of 0.726. For global longitudinal strain and extracellular volume, each 1% increase was associated with 1.333 and 1.300 times adjusted odds of diagnosis of stage B HF (both 0.05).
Subclinical dysfunction and myocardial fibrosis derived from CMR were progressively remarkable with advancing HF stage in DM. Comprehensive CMR provided sensitive tools for better delineation of DM patients with pre-HF and at risk for HF.
心脏磁共振成像（CMR）可作为一种强大的工具，用于全面评估根据美国心脏协会/美国心脏病学会指南分类的糖尿病（DM）患者心力衰竭（HF）各阶段的早期变化。
作者旨在通过CMR探索不同HF阶段DM参与者的表型影像特征。
对2020年1月至2021年12月期间接受CMR检查的射血分数保留的DM参与者进行评估。通过CMR评估左心室应变分析和心肌纤维化。
共评估了475名处于不同HF阶段的DM参与者（平均年龄56±12岁；326名男性）和78名健康对照者。在DM患者中，随着HF阶段的升高，绝对应变值显著降低。此外，HF B期和C期的早期舒张期应变率显著低于A期HF和对照者。DM患者的心肌细胞外容积随着HF阶段的进展而增加（A期，27.0%±2.9%；B期，29.1%±3.5%；C期，30.5%±4.1%；P<0.05）。在多变量逻辑回归分析中，早期舒张期纵向应变率（OR：2.184；95%CI：1.378 - 3.461；P = 0.001）是将A期DM参与者与对照者独立区分开来的重要因素，受试者操作特征曲线下面积为0.726。对于整体纵向应变和细胞外容积，每增加1%分别与诊断为B期HF的校正比值比增加1.333倍和1.300倍相关（均P<0.05）。
在DM患者中，CMR显示的亚临床功能障碍和心肌纤维化随着HF阶段的进展而逐渐显著。全面的CMR为更好地描绘HF前期和有HF风险的DM患者提供了敏感工具。
