Cardiovascular magnetic resonance measures of aortic stiffness in asymptomatic patients with type 2 diabetes: association with glycaemic control and clinical outcomes
Abstract Background We aimed to investigate in patients with type 2 diabetes whether aortic stiffness is: (i) associated with glycaemic control, (ii) associated with adverse outcomes and (iii) can be reversed on treatment with RAAS inhibition. Methods Patients with type 2 diabetes (N = 94) and low v...
| Main Authors: | , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2018-03-01
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| Series: | Cardiovascular Diabetology |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12933-018-0681-4 |
| _version_ | 1819047164703145984 |
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| author | Peter P. Swoboda Bara Erhayiem Rachel Kan Adam K. McDiarmid Pankaj Garg Tarique A. Musa Laura E. Dobson Klaus K. Witte Mark T. Kearney Julian H. Barth Ramzi Ajjan John P. Greenwood Sven Plein |
| author_facet | Peter P. Swoboda Bara Erhayiem Rachel Kan Adam K. McDiarmid Pankaj Garg Tarique A. Musa Laura E. Dobson Klaus K. Witte Mark T. Kearney Julian H. Barth Ramzi Ajjan John P. Greenwood Sven Plein |
| author_sort | Peter P. Swoboda |
| collection | DOAJ |
| description | Abstract Background We aimed to investigate in patients with type 2 diabetes whether aortic stiffness is: (i) associated with glycaemic control, (ii) associated with adverse outcomes and (iii) can be reversed on treatment with RAAS inhibition. Methods Patients with type 2 diabetes (N = 94) and low vascular risk underwent assessment of cardiovascular risk and CMR assessment of ascending aortic distensibility (AAD), descending aortic distensibility (DAD) and aortic pulse wave velocity (PWV). Of these patients a subgroup with recent onset microalbuminuria (N = 25) were treated with renin–angiotensin–aldosterone system (RAAS) inhibition and imaging repeated after 1 year. All 94 patients were followed up for 2.4 years for major adverse cardiovascular disease (CVD) events including myocardial infarction detected on late gadolinium enhancement CMR. Results Ascending aortic distensibility, DAD and PWV all had a significant association with age and 24 h systolic blood pressure but only AAD had a significant association with glycaemic control, measured as HbA1c (Beta − 0.016, P = 0.04). The association between HbA1c and AAD persisted even after correction for age and hypertension. CVD events occurred in 19/94 patients. AAD, but not DAD or PWV, was associated with CVD events (hazard ratio 0.49, 95% confidence interval 0.25–0.95, P = 0.01). On treatment with RAAS inhibition, AAD, but not DAD or PWV, showed significant improvement from 1.51 ± 1.15 to 1.97 ± 1.07 10−3 mmHg−1, P = 0.007. Conclusions Ascending aortic distensibility measured by CMR is independently associated with poor glycaemic control and adverse cardiovascular events. Furthermore it may be reversible on treatment with RAAS inhibition. AAD is a promising marker of cardiovascular risk in asymptomatic patients with type 2 diabetes and has potential use as a surrogate cardiovascular endpoint in studies of novel hypoglycaemic agents. Clinical trials registration https://clinicaltrials.gov/ct2/show/NCT01970319 |
| first_indexed | 2024-12-21T10:56:01Z |
| format | Article |
| id | doaj.art-f0e638cc9d5f4c4bb43edfcf7259f0f5 |
| institution | Directory Open Access Journal |
| issn | 1475-2840 |
| language | English |
| last_indexed | 2024-12-21T10:56:01Z |
| publishDate | 2018-03-01 |
| publisher | BMC |
| record_format | Article |
| series | Cardiovascular Diabetology |
| spelling | doaj.art-f0e638cc9d5f4c4bb43edfcf7259f0f52022-12-21T19:06:30ZengBMCCardiovascular Diabetology1475-28402018-03-011711910.1186/s12933-018-0681-4Cardiovascular magnetic resonance measures of aortic stiffness in asymptomatic patients with type 2 diabetes: association with glycaemic control and clinical outcomesPeter P. Swoboda0Bara Erhayiem1Rachel Kan2Adam K. McDiarmid3Pankaj Garg4Tarique A. Musa5Laura E. Dobson6Klaus K. Witte7Mark T. Kearney8Julian H. Barth9Ramzi Ajjan10John P. Greenwood11Sven Plein12Multidisciplinary Cardiovascular Research Centre & Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, LIGHT Laboratories, Clarendon Way, University of LeedsMultidisciplinary Cardiovascular Research Centre & Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, LIGHT Laboratories, Clarendon Way, University of LeedsMultidisciplinary Cardiovascular Research Centre & Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, LIGHT Laboratories, Clarendon Way, University of LeedsMultidisciplinary Cardiovascular Research Centre & Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, LIGHT Laboratories, Clarendon Way, University of LeedsMultidisciplinary Cardiovascular Research Centre & Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, LIGHT Laboratories, Clarendon Way, University of LeedsMultidisciplinary Cardiovascular Research Centre & Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, LIGHT Laboratories, Clarendon Way, University of LeedsMultidisciplinary Cardiovascular Research Centre & Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, LIGHT Laboratories, Clarendon Way, University of LeedsMultidisciplinary Cardiovascular Research Centre & Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, LIGHT Laboratories, Clarendon Way, University of LeedsMultidisciplinary Cardiovascular Research Centre & Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, LIGHT Laboratories, Clarendon Way, University of LeedsLeeds Teaching Hospitals NHS TrustMultidisciplinary Cardiovascular Research Centre & Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, LIGHT Laboratories, Clarendon Way, University of LeedsMultidisciplinary Cardiovascular Research Centre & Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, LIGHT Laboratories, Clarendon Way, University of LeedsMultidisciplinary Cardiovascular Research Centre & Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, LIGHT Laboratories, Clarendon Way, University of LeedsAbstract Background We aimed to investigate in patients with type 2 diabetes whether aortic stiffness is: (i) associated with glycaemic control, (ii) associated with adverse outcomes and (iii) can be reversed on treatment with RAAS inhibition. Methods Patients with type 2 diabetes (N = 94) and low vascular risk underwent assessment of cardiovascular risk and CMR assessment of ascending aortic distensibility (AAD), descending aortic distensibility (DAD) and aortic pulse wave velocity (PWV). Of these patients a subgroup with recent onset microalbuminuria (N = 25) were treated with renin–angiotensin–aldosterone system (RAAS) inhibition and imaging repeated after 1 year. All 94 patients were followed up for 2.4 years for major adverse cardiovascular disease (CVD) events including myocardial infarction detected on late gadolinium enhancement CMR. Results Ascending aortic distensibility, DAD and PWV all had a significant association with age and 24 h systolic blood pressure but only AAD had a significant association with glycaemic control, measured as HbA1c (Beta − 0.016, P = 0.04). The association between HbA1c and AAD persisted even after correction for age and hypertension. CVD events occurred in 19/94 patients. AAD, but not DAD or PWV, was associated with CVD events (hazard ratio 0.49, 95% confidence interval 0.25–0.95, P = 0.01). On treatment with RAAS inhibition, AAD, but not DAD or PWV, showed significant improvement from 1.51 ± 1.15 to 1.97 ± 1.07 10−3 mmHg−1, P = 0.007. Conclusions Ascending aortic distensibility measured by CMR is independently associated with poor glycaemic control and adverse cardiovascular events. Furthermore it may be reversible on treatment with RAAS inhibition. AAD is a promising marker of cardiovascular risk in asymptomatic patients with type 2 diabetes and has potential use as a surrogate cardiovascular endpoint in studies of novel hypoglycaemic agents. Clinical trials registration https://clinicaltrials.gov/ct2/show/NCT01970319http://link.springer.com/article/10.1186/s12933-018-0681-4Cardiovascular magnetic resonanceAortic distensibilityPulse wave velocityCardiovascular riskRenin–angiotensin–aldosterone |
| spellingShingle | Peter P. Swoboda Bara Erhayiem Rachel Kan Adam K. McDiarmid Pankaj Garg Tarique A. Musa Laura E. Dobson Klaus K. Witte Mark T. Kearney Julian H. Barth Ramzi Ajjan John P. Greenwood Sven Plein Cardiovascular magnetic resonance measures of aortic stiffness in asymptomatic patients with type 2 diabetes: association with glycaemic control and clinical outcomes Cardiovascular Diabetology Cardiovascular magnetic resonance Aortic distensibility Pulse wave velocity Cardiovascular risk Renin–angiotensin–aldosterone |
| title | Cardiovascular magnetic resonance measures of aortic stiffness in asymptomatic patients with type 2 diabetes: association with glycaemic control and clinical outcomes |
| title_full | Cardiovascular magnetic resonance measures of aortic stiffness in asymptomatic patients with type 2 diabetes: association with glycaemic control and clinical outcomes |
| title_fullStr | Cardiovascular magnetic resonance measures of aortic stiffness in asymptomatic patients with type 2 diabetes: association with glycaemic control and clinical outcomes |
| title_full_unstemmed | Cardiovascular magnetic resonance measures of aortic stiffness in asymptomatic patients with type 2 diabetes: association with glycaemic control and clinical outcomes |
| title_short | Cardiovascular magnetic resonance measures of aortic stiffness in asymptomatic patients with type 2 diabetes: association with glycaemic control and clinical outcomes |
| title_sort | cardiovascular magnetic resonance measures of aortic stiffness in asymptomatic patients with type 2 diabetes association with glycaemic control and clinical outcomes |
| topic | Cardiovascular magnetic resonance Aortic distensibility Pulse wave velocity Cardiovascular risk Renin–angiotensin–aldosterone |
| url | http://link.springer.com/article/10.1186/s12933-018-0681-4 |
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