The independent association of myocardial extracellular volume and myocardial blood flow with cardiac diastolic function in patients with type 2 diabetes: a prospective cross-sectional cohort study
Abstract Background Diffuse myocardial fibrosis and microvascular dysfunction are suggested to underlie cardiac dysfunction in patients with type 2 diabetes, but studies investigating their relative impact are lacking. We aimed to study imaging biomarkers of these and hypothesized that fibrosis and...
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| Format: | Article |
| Language: | English |
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BMC
2023-03-01
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| Series: | Cardiovascular Diabetology |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12933-023-01804-9 |
| _version_ | 1797854071673061376 |
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| author | Annemie S. Bojer Martin H. Sørensen Stine H. Madsen David A. Broadbent Sven Plein Peter Gæde Per L. Madsen |
| author_facet | Annemie S. Bojer Martin H. Sørensen Stine H. Madsen David A. Broadbent Sven Plein Peter Gæde Per L. Madsen |
| author_sort | Annemie S. Bojer |
| collection | DOAJ |
| description | Abstract Background Diffuse myocardial fibrosis and microvascular dysfunction are suggested to underlie cardiac dysfunction in patients with type 2 diabetes, but studies investigating their relative impact are lacking. We aimed to study imaging biomarkers of these and hypothesized that fibrosis and microvascular dysfunction would affect different phases of left ventricular (LV) diastole. Methods In this cross-sectional study myocardial blood flow (MBF) at rest and adenosine-stress and perfusion reserve (MPR), as well as extracellular volume fraction (ECV), were determined with cardiovascular magnetic resonance (CMR) imaging in 205 patients with type 2 diabetes and 25 controls. Diastolic parameters included echocardiography-determined lateral e’ and average E/e’, and CMR-determined (rest and chronotropic-stress) LV early peak filling rate (ePFR), LV peak diastolic strain rate (PDSR), and left atrial (LA) volume changes. Results In multivariable analysis adjusted for possible confounders including each other (ECV for blood flow and vice versa), a 10% increase of ECV was independently associated with ePFR/EDV (rest: β = − 4.0%, stress: β = − 7.9%), LAmax /BSA (rest: β = 4.8%, stress: β = 5.8%), and circumferential (β = − 4.1%) and radial PDSR (β = 0.07%/sec). A 10% stress MBF increase was associated with lateral e′ (β = 1.4%) and average E/e’ (β = − 1.4%) and a 10% MPR increase to lateral e′ (β = 2.7%), and average E/e’ (β = − 2.8%). For all the above, p < 0.05. No associations were found with longitudinal PDSR or left atrial total emptying fraction. Conclusion In patients with type 2 diabetes, imaging biomarkers of microvascular dysfunction and diffuse fibrosis impacts diastolic dysfunction independently of each other. Microvascular dysfunction primarily affects early left ventricular relaxation. Diffuse fibrosis primarily affects diastasis. Trial registration https://www.clinicaltrials.gov . Unique identifier: NCT02684331. Date of registration: February 18, 2016. |
| first_indexed | 2024-04-09T20:01:08Z |
| format | Article |
| id | doaj.art-a617f8c4784640e6ba2313eb4c269bb9 |
| institution | Directory Open Access Journal |
| issn | 1475-2840 |
| language | English |
| last_indexed | 2024-04-09T20:01:08Z |
| publishDate | 2023-03-01 |
| publisher | BMC |
| record_format | Article |
| series | Cardiovascular Diabetology |
| spelling | doaj.art-a617f8c4784640e6ba2313eb4c269bb92023-04-03T05:15:22ZengBMCCardiovascular Diabetology1475-28402023-03-0122111210.1186/s12933-023-01804-9The independent association of myocardial extracellular volume and myocardial blood flow with cardiac diastolic function in patients with type 2 diabetes: a prospective cross-sectional cohort studyAnnemie S. Bojer0Martin H. Sørensen1Stine H. Madsen2David A. Broadbent3Sven Plein4Peter Gæde5Per L. Madsen6Department of Cardiology and Endocrinology, Slagelse HospitalDepartment of Cardiology and Endocrinology, Slagelse HospitalDepartment of Cardiology, Copenhagen University Hospital Herlev-GentofteDepartment of Medical Physics and Engineering, Leeds Teaching Hospitals NHS TrustLeeds Institute of Cardiovascular and Metabolic Medicine, University of LeedsDepartment of Cardiology and Endocrinology, Slagelse HospitalDepartment of Cardiology, Copenhagen University Hospital Herlev-GentofteAbstract Background Diffuse myocardial fibrosis and microvascular dysfunction are suggested to underlie cardiac dysfunction in patients with type 2 diabetes, but studies investigating their relative impact are lacking. We aimed to study imaging biomarkers of these and hypothesized that fibrosis and microvascular dysfunction would affect different phases of left ventricular (LV) diastole. Methods In this cross-sectional study myocardial blood flow (MBF) at rest and adenosine-stress and perfusion reserve (MPR), as well as extracellular volume fraction (ECV), were determined with cardiovascular magnetic resonance (CMR) imaging in 205 patients with type 2 diabetes and 25 controls. Diastolic parameters included echocardiography-determined lateral e’ and average E/e’, and CMR-determined (rest and chronotropic-stress) LV early peak filling rate (ePFR), LV peak diastolic strain rate (PDSR), and left atrial (LA) volume changes. Results In multivariable analysis adjusted for possible confounders including each other (ECV for blood flow and vice versa), a 10% increase of ECV was independently associated with ePFR/EDV (rest: β = − 4.0%, stress: β = − 7.9%), LAmax /BSA (rest: β = 4.8%, stress: β = 5.8%), and circumferential (β = − 4.1%) and radial PDSR (β = 0.07%/sec). A 10% stress MBF increase was associated with lateral e′ (β = 1.4%) and average E/e’ (β = − 1.4%) and a 10% MPR increase to lateral e′ (β = 2.7%), and average E/e’ (β = − 2.8%). For all the above, p < 0.05. No associations were found with longitudinal PDSR or left atrial total emptying fraction. Conclusion In patients with type 2 diabetes, imaging biomarkers of microvascular dysfunction and diffuse fibrosis impacts diastolic dysfunction independently of each other. Microvascular dysfunction primarily affects early left ventricular relaxation. Diffuse fibrosis primarily affects diastasis. Trial registration https://www.clinicaltrials.gov . Unique identifier: NCT02684331. Date of registration: February 18, 2016.https://doi.org/10.1186/s12933-023-01804-9DiabetesDiabetes complicationsCardiac diastolic functionCardiac magnetic resonance imagingMyocardial extracellular volumeMyocardial perfusion reserve |
| spellingShingle | Annemie S. Bojer Martin H. Sørensen Stine H. Madsen David A. Broadbent Sven Plein Peter Gæde Per L. Madsen The independent association of myocardial extracellular volume and myocardial blood flow with cardiac diastolic function in patients with type 2 diabetes: a prospective cross-sectional cohort study Cardiovascular Diabetology Diabetes Diabetes complications Cardiac diastolic function Cardiac magnetic resonance imaging Myocardial extracellular volume Myocardial perfusion reserve |
| title | The independent association of myocardial extracellular volume and myocardial blood flow with cardiac diastolic function in patients with type 2 diabetes: a prospective cross-sectional cohort study |
| title_full | The independent association of myocardial extracellular volume and myocardial blood flow with cardiac diastolic function in patients with type 2 diabetes: a prospective cross-sectional cohort study |
| title_fullStr | The independent association of myocardial extracellular volume and myocardial blood flow with cardiac diastolic function in patients with type 2 diabetes: a prospective cross-sectional cohort study |
| title_full_unstemmed | The independent association of myocardial extracellular volume and myocardial blood flow with cardiac diastolic function in patients with type 2 diabetes: a prospective cross-sectional cohort study |
| title_short | The independent association of myocardial extracellular volume and myocardial blood flow with cardiac diastolic function in patients with type 2 diabetes: a prospective cross-sectional cohort study |
| title_sort | independent association of myocardial extracellular volume and myocardial blood flow with cardiac diastolic function in patients with type 2 diabetes a prospective cross sectional cohort study |
| topic | Diabetes Diabetes complications Cardiac diastolic function Cardiac magnetic resonance imaging Myocardial extracellular volume Myocardial perfusion reserve |
| url | https://doi.org/10.1186/s12933-023-01804-9 |
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