Cohort comparison study of cardiac disease and atherosclerotic burden in type 2 diabetic adults using whole body cardiovascular magnetic resonance imaging

Cardiovascular Diabetology

J. Graeme Houston⁵  Helen M. Colhoun¹  Helen Looker¹  Petra Rauchhaus²  Lynne McCormick⁴  Deirdre B. Cassidy⁴  Shona Z. Matthew⁴  Stephen J. Gandy³  Jonathan R. Weir-McCall⁵  Suzanne L. Duce⁴ 

[1] Division of Population Health Sciences, Medical Research Institute, University of Dundee, The Mackenzie Building, Dundee DD2 4BF, UK;Dundee Epidemiological and Biostatistics Unit, University of Dundee, Dundee DD1 9SY, UK;NHS Tayside Medical Physics, Ninewells Hospital, Dundee DD1 9SY, UK;Division of Cardiovascular and Diabetes Medicine, Medical Research Institute, University of Dundee, Level 7, Ninewells Hospital, Dundee DD1 9SY, UK;NHS Tayside Clinical Radiology, Ninewells Hospital, Dundee DD1 9SY, UK

关键词: T2DM;    Type 2 diabetes mellitus;    Atheroma score;    Atherosclerosis;    Cardiovascular disease;    WB CVMR;    LVA;    CMR;    Magnetic resonance angiography;    Whole body MRI;   

Others  :  1225627
DOI  :  10.1186/s12933-015-0284-2

 received in 2015-06-25, accepted in 2015-09-08,  发布年份 2015

【 摘 要 】

Background

Whole body cardiovascular MR (WB CVMR) combines whole body angiography and cardiac MR assessment. It is accepted that there is a high disease burden in patients with diabetes, however the quantification of the whole body atheroma burden in both arterial and cardiac disease has not been previously reported. In this study we compare the quantified atheroma burden in those individuals with and without diabetes by clinical cardiovascular disease (CVD) status.

Methods

158 participants underwent WB CVMR, and were categorised into one of four groups: (1) type 2 diabetes mellitus (T2DM) with CVD; (2) T2DM without CVD; (3) CVD without T2DM; (4) healthy controls. The arterial tree was subdivided into 31 segments and each scored according to the degree of stenosis. From this a standardised atheroma score (SAS) was calculated. Cardiac MR and late gadolinium enhancement images of the left ventricle were obtained for assessment of mass, volume and myocardial scar assessment.

Results

148 participants completed the study protocol—61 % male, with mean age of 64 ± 8.2 years. SAS was highest in those with cardiovascular disease without diabetes [10.1 (0–39.5)], followed by those with T2DM and CVD [4 (0–41.1)], then those with T2DM only [3.23 (0–19.4)] with healthy controls having the lowest atheroma score [2.4 (0–19.4)]. Both groups with a prior history of CVD had a higher SAS and left ventricular mass than those without (p < 0.001 for both). However after accounting for known cardiovascular risk factors, only the SAS in the group with CVD without T2DM remained significantly elevated. 6 % of the T2DM group had evidence of silent myocardial infarct, with this subcohort having a higher SAS than the remainder of the T2DM group [7.7 (4–19) vs. 2.8 (0–17), p = 0.024].

Conclusions

Global atheroma burden was significantly higher in those with known cardiovascular disease and without diabetes but not in those with diabetes and cardiovascular disease suggesting that cardiovascular events may occur at a lower atheroma burden in diabetes.

【 授权许可】

   
2015 Duce et al.

【 图 表 】

Fig.1.

Fig.2.

Fig.3.

【 参考文献 】

• [1]Alberti KG, Zimmet PZ. Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus provisional report of a WHO consultation. Diabet Med. 1998; 15:539-553.
• [2]Zimmet P, Alberti KG, Shaw J. Global and societal implications of the diabetes epidemic. Nature. 2001; 414:782-787.
• [3]Danaei G, Lawes CMM, Vander Hoorn S, Murray CJL, Ezzati M. Global and regional mortality from ischaemic heart disease and stroke attributable to higher-than-optimum blood glucose concentration: comparative risk assessment. Lancet. 2006; 368:1651-1659.
• [4]Rubin RR, Peyrot M. Quality of life and diabetes. Diabetes Metab Res Rev. 1999; 15:205-218.
• [5]Bhatt DL, Eagle KA, Ohman EM, Hirsch AT, Goto S, Mahoney EM, Wilson PWF, Alberts MJ, D’Agostino R, Liau C-S, Mas J-L, Röther J, Smith SC, Salette G, Contant CF, Massaro JM, Steg PG. Comparative determinants of 4-year cardiovascular event rates in stable outpatients at risk of or with atherothrombosis. JAMA. 2010; 304:1350-1357.
• [6]Ladd SC, Debatin JF, Stang A, Bromen K, Moebus S, Nuefer M, Gizewski E, Wanke I, Doerfler A, Ladd ME, Benemann J, Erbel R, Forsting M, Schmermund A, Jöckel K-H. Whole-body MR vascular screening detects unsuspected concomitant vascular disease in coronary heart disease patients. Eur Radiol. 2007; 17:1035-1045.
• [7]Gandy SJ, Lambert M, Belch JJF, Cavin ID, Crowe E, Littleford R, Macfarlane JA, Matthew SZ, Martin P, Nicholas RS, Struthers AD, Sullivan F, Waugh SA, White RD, Weir-McCall JR, Houston JG. Technical assessment of whole body angiography and cardiac function within a single MRI examination. Clin Radiol. 2015; 70(6):595-603.
• [8]Findeisen HM, Weckbach S, Stark RG, Reiser MF, Schoenberg SO, Parhofer KG. Metabolic syndrome predicts vascular changes in whole body magnetic resonance imaging in patients with long standing diabetes mellitus. Cardiovasc Diabetol. 2010; 9:44. BioMed Central Full Text
• [9]Bamberg F, Parhofer KG, Lochner E, Marcus RP, Theisen D, Findeisen HM, Hoffmann U, Schönberg SO, Schlett CL, Reiser MF, Weckbach S. Diabetes mellitus: long-term prognostic value of whole-body mr imaging for the occurrence of cardiac and cerebrovascular events. Radiology. 2013; 269:730-737.
• [10]Waugh SA, Ramkumar PG, Gandy SJ, Nicholas RS, Martin P, Belch JJF, Struthers AD, Houston JG. Optimization of the contrast dose and injection rates in whole-body MR angiography at 3.0T. J Magn Reson Imaging. 2009; 30:1059-1067.
• [11]Nielsen YW, Eiberg JP, Logager VB, Schroeder TV, Just S, Thomsen HS. Whole-body magnetic resonance angiography at 3 tesla using a hybrid protocol in patients with peripheral arterial disease. Cardiovasc Interv Radiol. 2009; 32:877-886.
• [12]Weir-McCall JR, Khan F, Lambert MA, Adamson CL, Gardner M, Gandy SJ, Ramkumar PG, Belch JJF, Struthers AD, Rauchhaus P, Morris AD, Houston JG. Common carotid intima media thickness and ankle-brachial pressure index correlate with local but not global atheroma burden: a cross sectional study using whole body magnetic resonance angiography. PLoS One. 2014; 9:e99190.
• [13]Natori S, Lai S, Finn JP, Gomes AS, Hundley WG, Jerosch-Herold M, Pearson G, Sinha S, Arai A, Lima JAC, Bluemke DA. Cardiovascular function in multi-ethnic study of atherosclerosis: normal values by age, sex, and ethnicity. AJR Am J Roentgenol. 2006; 186(6 Suppl 2):S357-S365.
• [14]Mewton N, Opdahl A, Choi E-Y, Almeida ALC, Kawel N, Wu CO, Burke GL, Liu S, Liu K, Bluemke DA, Lima JAC. Left ventricular global function index by magnetic resonance imaging–a novel marker for assessment of cardiac performance for the prediction of cardiovascular events: the multi-ethnic study of atherosclerosis. Hypertension. 2013; 61:770-778.
• [15]Burke AP, Kolodgie FD, Zieske A, Fowler DR, Weber DK, Varghese PJ, Farb A, Virmani R. Morphologic findings of coronary atherosclerotic plaques in diabetics: a postmortem study. Arterioscler Thromb Vasc Biol. 2004; 24:1266-1271.
• [16]Moreno PR, Murcia AM, Palacios IF, Leon MN, Bernardi VH, Fuster V, Fallon JT. Coronary composition and macrophage infiltration in atherectomy specimens from patients with diabetes mellitus. Circulation. 2000; 102:2180-2184.
• [17]Edsfeldt A, Gonçalves I, Grufman H, Nitulescu M, Dunér P, Bengtsson E, Mollet IG, Persson A, Nilsson M, Orho-Melander M, Melander O, Björkbacka H, Nilsson J. Impaired fibrous repair: a possible contributor to atherosclerotic plaque vulnerability in patients with type II diabetes. Arterioscler Thromb Vasc Biol. 2014;2143–50.
• [18]Kubo T, Imanishi T, Takarada S, Kuroi A, Ueno S, Yamano T, Tanimoto T, Matsuo Y, Masho T, Kitabata H, Tsuda K, Tomobuchi Y, Akasaka T. Assessment of culprit lesion morphology in acute myocardial infarction: ability of optical coherence tomography compared with intravascular ultrasound and coronary angioscopy. J Am Coll Cardiol. 2007; 50:933-939.
• [19]Spagnoli LG, Mauriello A, Sangiorgi G, Fratoni S, Bonanno E, Schwartz RS, Piepgras DG, Pistolese R, Ippoliti A, Holmes DR. Extracranial thrombotically active carotid plaque as a risk factor for ischemic stroke. JAMA. 2004; 292:1845-1852.
• [20]Kawata T, Daimon M, Hasegawa R, Toyoda T, Sekine T, Himi T, Uchida D, Miyazaki S, Hirose K, Ichikawa R, Maruyama M, Suzuki H, Daida H. Prognostic value of coronary flow reserve assessed by transthoracic Doppler echocardiography on long-term outcome in asymptomatic patients with type 2 diabetes without overt coronary artery disease. Cardiovasc Diabetol. 2013; 12:121. BioMed Central Full Text
• [21]Tuccillo B, Accadia M, Rumolo S, Iengo R, D’Andrea A, Granata G, Sacra C, Guarini P, Al-Kebsi M, De Michele M, Ascione L. Factors predicting coronary flow reserve impairment in patients evaluated for chest pain: an ultrasound study. J Cardiovasc Med (Hagerstown). 2008; 9:251-255.
• [22]Weckbach S, Findeisen HM, Schoenberg SO, Kramer H, Stark R, Clevert DA, Reiser MF, Parhofer KG. Systemic cardiovascular complications in patients with long-standing diabetes mellitus: comprehensive assessment with whole-body magnetic resonance imaging/magnetic resonance angiography. Invest Radiol. 2009; 44:242-250.
• [23]Hansen T, Ahlström H, Söderberg S, Hulthe J, Wikström J, Lind L, Johansson L. Visceral adipose tissue, adiponectin levels and insulin resistance are related to atherosclerosis as assessed by whole-body magnetic resonance angiography in an elderly population. Atherosclerosis. 2009; 205:163-167.
• [24]Lehrke S, Egenlauf B, Steen H, Lossnitzer D, Korosoglou G, Merten C, Ivandic BT, Giannitsis E. Katus H a: Prediction of coronary artery disease by a systemic atherosclerosis score index derived from whole-body MR angiography. J Cardiovasc Magn Reson. 2009; 11:36. BioMed Central Full Text
• [25]Pajunen P, Nieminen MS, Taskinen MR, Syvänne M. Quantitative comparison of angiographic characteristics of coronary artery disease in patients with noninsulin-dependent diabetes mellitus compared with matched nondiabetic control subjects. Am J Cardiol. 1997; 80:550-556.
• [26]Syvänne M, Pajunen P, Kahri J, Lahdenperä S, Ehnholm C, Nieminen MS, Taskinen MR. Determinants of the severity and extent of coronary artery disease in patients with type-2 diabetes and in nondiabetic subjects. Coron Artery Dis. 2001; 12:99-106.
• [27]Migrino RQ, Bowers M, Harmann L, Prost R, LaDisa JF. Carotid plaque regression following 6-month statin therapy assessed by 3 T cardiovascular magnetic resonance: comparison with ultrasound intima media thickness. J Cardiovasc Magn Reson. 2011; 13:37. BioMed Central Full Text
• [28]Ito S, Suzuki T, Katoh O, Ojio S, Sato H, Ehara M, Ito T, Myoishi M, Kawase Y, Kurokawa R, Suzuki Y, Sato K, Toyama J, Fukutomi T, Itoh M. The influence of diabetes mellitus on plaque volume and vessel size in patients undergoing percutaneous coronary intervention. Jpn Heart J. 2004; 45:573-580.
• [29]Maffei E, Seitun S, Nieman K, Martini C, Guaricci AI, Tedeschi C, Weustink AC, Mollet NR, Berti E, Grilli R, Messalli G, Cademartiri F. Assessment of coronary artery disease and calcified coronary plaque burden by computed tomography in patients with and without diabetes mellitus. Eur Radiol. 2011; 21:944-953.
• [30]Hansen T, Ahlström H, Wikström J, Lind L, Johansson L. A total atherosclerotic score for whole-body MRA and its relation to traditional cardiovascular risk factors. Eur Radiol. 2008; 18:1174-1180.
• [31]De Lorenzo A, Lima RS, Siqueira-Filho AG, Pantoja MR. Prevalence and prognostic value of perfusion defects detected by stress technetium-99 m sestamibi myocardial perfusion single-photon emission computed tomography in asymptomatic patients with diabetes mellitus and no known coronary artery disease. Am J Cardiol. 2002; 90:827-832.
• [32]Langer A, Freeman MR, Josse RG, Steiner G, Armstrong PW. Detection of silent myocardial ischemia in diabetes mellitus. Am J Cardiol. 1991; 67:1073-1078.
• [33]Burgess DC, Hunt D, Li L, Zannino D, Williamson E, Davis TME, Laakso M, Kesäniemi YA, Zhang J, Sy RW, Lehto S, Mann S, Keech AC. Incidence and predictors of silent myocardial infarction in type 2 diabetes and the effect of fenofibrate: an analysis from the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) study. Eur Heart J. 2010; 31:92-99.
• [34]Lundberg C, Johansson L, Barbier CE, Lind L, Ahlström H, Hansen T. Total atherosclerotic burden by whole body magnetic resonance angiography predicts major adverse cardiovascular events. Atherosclerosis. 2013; 228:148-152.
• [35]Sakuma H. Coronary CT versus MR angiography: the role of MR. Radiology. 2011; 258(2):340-9.