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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 
ORCID: https://orcid.org/0000-0002-5483-169X, Greenwood, John P., Plein, Sven and Swoboda, Peter P.
(2024)
Occult coronary microvascular dysfunction and ischemic heart disease in patients with diabetes and heart failure.
Journal of Cardiovascular Magnetic Resonance, 26 (2).
ISSN 1097-6647
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Abstract
Background: 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. Methods: 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). Results: 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. Conclusion: 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.
| Item Type: | Article |
|---|---|
| Additional Information: | Availability of data and materials: The datasets used and analyzed during the current study are available from the corresponding author on reasonable request. Funding information: This research was funded by British Heart Foundation (RG/16/1/32092). S.P. is supported by a British Heart Foundation Chair (CH/16/2/32089). E.L. acknowledges support from the Wellcome Trust (221690/Z/20/Z). This research is supported by the National Institute for Health Research (NIHR) through the Local Clinical Research Networks and the Leeds Clinical Research Facility. |
| Uncontrolled Keywords: | cardiovascular magnetic resonance (cmr),coronary microvascular dysfunction (cmd),diabetes mellitus (dm),heart failure (hf),myocardial blood flow (mbf),myocardial perfusion reserve (mpr),cardiology and cardiovascular medicine,family practice,radiological and ultrasound technology,radiology nuclear medicine and imaging,sdg 3 - good health and well-being ,/dk/atira/pure/subjectarea/asjc/2700/2705 |
| Faculty \ School: | Faculty of Medicine and Health Sciences > Norwich Medical School |
| UEA Research Groups: | Faculty of Medicine and Health Sciences > Research Centres > Metabolic Health |
| Related URLs: | |
| Depositing User: | LivePure Connector |
| Date Deposited: | 08 Aug 2024 14:30 |
| Last Modified: | 30 Sep 2024 13:30 |
| URI: | https://ueaeprints.uea.ac.uk/id/eprint/96187 |
| DOI: | 10.1016/j.jocmr.2024.101073 |
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