Patients with T1D and high CV risk show pathological T1 time values and an increased percentage of extracellular myocardial volume on cardiac MRI

Czech version

Authors: Peter Novodvorský ^1,2; Michal Dubský ¹; Natália Marhefková ¹; Theodor Adla ³; Robert Roland ⁴; Michal Pazderník ⁴; Martin Haluzík ^1,5; Pankaj Garg ⁶
Authors‘ workplace: Centrum diabetologie IKEM, Praha ¹; metabolické centrum s. r. o., Trenčín ²; Pracoviště zobrazovacích metod (PZM) IKEM, Praha ³; Klinika kardiologie IKEM, Praha ⁴; Ústav lékařské biochemie a laboratorní diagnostiky 1. LF UK a VFN v Praze ⁵; Norwich Medical School, University of East Anglia, Norwich, United Kingdom ⁶
Published in: Diab Obez 2025; 25(2): 89-94
Category: Reviews

Overview

Introduction: Diffuse myocardial fibrosis is a negative CV prognostic marker. We employed advanced cardiac MRI (CMR) techniques for detailed left ventricular myocardial tissue characterisation people with type 1 diabetes (PwT1D) and high CV risk. Methods: Quantitative native T1 mapping (T1) and extracellular volume fraction (ECV) calculation of the whole left ventricular myocardial volume (LVMV) was done (1.5T Avanto Fit, Siemens) in PwT1D and high CV risk (CAC score > 400 and/or presence of ≥ 2 atherosclerotic plaques in the carotids) but without clinical diagnosis of CVD or heart failure. Percentage of LVMV above the normal values for T1 (> 1 100 ms) and ECV (> 28 %) was calculated. Results: Twelve PwT1D (8/12 women) with mean (SD) [range] age 65 (2) [60–67] years, diabetes duration 36 (12) [16–56] years, HbA_1c 7.5 (0.9) [6.0–8.8] %, LV EF 66 (7) [54–77] % were analysed. Mean (SD) [range] native T1 time was 1 060 (41) [996–1138] ms and the % of LVMV >1100 ms was 27 (11) [14–47] %. Mean (SD) [range] ECV was 28.6 (3.5) [23–33] % and the % of LVMV >28 % was 47 (21) [7–78] %. Conclusion: This is the first CMR study which has applied threshold values to native T1 and ECV data for the whole LVMV in PwT1D. We demonstrate large myocardial areas which are above the normal values. Clinical implications of our findings will require further evaluation on larger populations.

Keywords:

type 1 diabetes – diabetic cardiomyopathy – cardiac MRI – extracellular volume fraction (ECV)

Sources

Iqbal A, Novodvorsky P, Heller SR. Recent Updates on Type 1 Diabetes Mellitus Management for Clinicians. Diabetes Metab J 2018; 42(1): 3–18. Dostupné z DOI: <http://dx.doi.org/10.4093/dmj.2018.42.1.3>. Erratum in: Diabetes Metab J 2018; 42(2): 177. Dostupné z DOI: <http://dx.doi.org/10.4093/dmj.2018.42.2.177>.

Nishimura R, LaPorte RE, Dorman JS et al. Mortality trends in type 1 diabetes. The Allegheny County (Pennsylvania) Registry 1965–1999. Diabetes Care 2001; 24(5): 823–827. Dostupné z DOI: <http://dx.doi.org/10.2337/diacare.24.5.823>.

Miller RG, Secrest AM, Sharma RK et al. Improvements in the life expectancy of type 1 diabetes: the Pittsburgh Epidemiology of Diabetes Complications study cohort. Diabetes 2012; 61(11): 2987–2992. Dostupné z DOI: <http://dx.doi.org/10.2337/db11–1625>.

Schnell O, Cappuccio F, Genovese S et al. Type 1 diabetes and cardiovascular disease. Cardiovasc Diabetol 2013; 12 : 156. Dostupné z DOI: <http://dx.doi.org/10.1186/1475–2840–12–156>.

Koivisto VA, Stevens LK, Mattock M et al. Cardiovascular disease and its risk factors in IDDM in Europe. EURODIAB IDDM Complications Study Group. Diabetes Care 1996; 19(7): 689–697. Dostupné z DOI: <http://dx.doi.org/10.2337/diacare.19.7.689>.

Laing SP, Swerdlow AJ, Slater SD et al. Mortality from heart disease in a cohort of 23,000 patients with insulin-treated diabetes. Diabetologia 2003; 46(6): 760–765. Dostupné z DOI: <http://dx.doi.org/10.1007/s00125–003–1116–6>.

Kannel WB, Hjortland M, Castelli WP. Role of diabetes in congestive heart failure: the Framingham study. Am J Cardiol 1974; 34(1): 29–34. Dostupné z DOI: <http://dx.doi.org/10.1016/0002–9149(74)90089–7>.

Stratton IM, Adler AI, Neil HA et al. Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study. BMJ 2000; 321(7258): 405–412. Dostupné z DOI: <http://dx.doi.org/10.1136/bmj.321.7258.405>.

Gottdiener JS, Arnold AM, Aurigemma GP et al. Predictors of congestive heart failure in the elderly: the Cardiovascular Health Study. J Am Coll Cardiol 2000; 35(6): 1628–1637. Dostupné z DOI: <http://dx.doi.org/10.1016/s0735–1097(00)00582–9>.

Aneja A, Tang WH, Bansilal S et al. Diabetic cardiomyopathy: insights into pathogenesis, diagnostic challenges, and therapeutic options. Am J Med 2008; 121(9): 748–757. Dostupné z DOI: <http://dx.doi.org/10.1016/j.amjmed.2008.03.046>.

Seferovic PM, Paulus WJ. Clinical diabetic cardiomyopathy: a two-faced disease with restrictive and dilated phenotypes. Eur Heart J 2015; 36(27): 1718–1727. 1727a-1727c. Dostupné z DOI: <http://dx.doi.org/10.1093/eurheartj/ehv134>.

Holscher ME, Bode C, Bugger H. Diabetic Cardiomyopathy: Does the Type of Diabetes Matter? Int J Mol Sci 2016; 17(12): 2136. Dostupné z DOI: <http://dx.doi.org/10.3390/ijms17122136>.

Wynn TA. Cellular and molecular mechanisms of fibrosis. J Pathol 2008; 214(2): 199–210. Dostupné z DOI: <http://dx.doi.org/10.1002/path.2277>.

Pepys MB. Amyloidosis. Annu Rev Med 2006; 57 : 223–241. Dostupné z DOI: <http://dx.doi.org/10.1146/annurev.med.57.121304.131243>.

Haaf P, Garg P, Messroghli DR et al. Cardiac T1 Mapping and Extracellular Volume (ECV) in clinical practice: a comprehensive review. J Cardiovasc Magn Reson 2016; 18(1): 89. Dostupné z DOI: <http://dx.doi.org/10.1186/s12968–016–0308–4>.

Weber KT, Brilla CG. Pathological hypertrophy and cardiac interstitium. Fibrosis and renin-angiotensin-aldosterone system. Circulation 1991; 83(6): 1849–1865. Dostupné z DOI: <http://dx.doi.org/10.1161/01.cir.83.6.1849>.

Tamarappoo BK, John BT, Reinier K et al. Vulnerable myocardial interstitium in patients with isolated left ventricular hypertrophy and sudden cardiac death: a postmortem histological evaluation. J Am Heart Assoc 2012; 1(3): e001511. Dostupné z DOI: <http://dx.doi.org/10.1161/JAHA.112.001511>.

Wong TC, Piehler KM, Meier CG et al. Association between extracellular matrix expansion quantified by cardiovascular magnetic resonance and short-term mortality. Circulation 2012; 126(10): 1206–1216. Dostupné z DOI: <http://dx.doi.org/10.1161/CIRCULATIONAHA.111.089409>.

Wong TC, Piehler KM, Kang IA et al. Myocardial extracellular volume fraction quantified by cardiovascular magnetic resonance is increased in diabetes and associated with mortality and incident heart failure admission. Eur Heart J 2014; 35(10): 657–664. Dostupné z DOI: <http://dx.doi.org/10.1093/eurheartj/eht193>.

Sado DM, Flett AS, Banypersad SM et al. Cardiovascular magnetic resonance measurement of myocardial extracellular volume in health and disease. Heart 2012; 98(19): 1436–1441. Dostupné z DOI: <http://dx.doi.org/10.1136/heartjnl-2012–302346>.

Ambale-Venkatesh B, Lima JA. Cardiac MRI: a central prognostic tool in myocardial fibrosis. Nat Rev Cardiol 2015; 12(1): 18–29. Dostupné z DOI: <http://dx.doi.org/10.1038/nrcardio.2014.159>.