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The microvascular effects of insulin resistance and diabetes on cardiac structure, function, and perfusion: a

Abdulghani M Larghat1, Peter P Swoboda2, John D Biglands3

  • 1Multidisciplinary Cardiovascular Research Centre & Leeds Institute of Genetics, Health and Therapeutics, University of Leeds, Leeds LS2 9JT, UK Department of Cardiology and Internal Medicine, Tripoli Medical Centre, Faculty of Medicine, University of Tripoli, Tripoli, Libya.

European Heart Journal. Cardiovascular Imaging
|August 14, 2014
PubMed

Insights

Type 2 diabetes leads to increased left-ventricular mass and torsion, with reduced myocardial perfusion reserve. This suggests microvascular disease contributes to cardiac dysfunction in diabetic patients.

Area of Science:

  • Cardiology
  • Diabetology
  • Medical Imaging

Background:

  • Type 2 diabetes mellitus is a known risk factor for heart failure.
  • Understanding the mechanisms linking diabetes and heart failure is crucial for patient outcomes.

Purpose of the Study:

  • To investigate cardiac structure, function, and perfusion in patients with and without type 2 diabetes.
  • To elucidate the relationship between diabetes, microvascular function, and cardiac remodeling.

Main Methods:

  • Comprehensive cardiovascular magnetic resonance (CMR) assessment in 65 patients (19 diabetes, 46 non-diabetes including prediabetes and controls).
  • Analysis of left-ventricular (LV) mass, relative wall mass (RWM), Lagrangian circumferential strain, LV torsion, and myocardial perfusion reserve (MPR).
  • Invasive coronary angiography performed to exclude significant coronary stenosis (>30%).

Main Results:

  • Diabetic patients exhibited significantly higher LV mass (112.8 ± 39.7 g) compared to non-diabetics (91.5 ± 21.3 g, P=0.01) and prediabetics (90.3 ± 18.7 g, P=0.02).
  • LV torsion angle was significantly increased in diabetics (9.65 ± 1.90°) versus non-diabetics (8.59 ± 1.91°, P=0.047).
  • Myocardial perfusion reserve (MPR) was significantly lower in diabetics (2.10 ± 0.76 mL/g/min) compared to non-diabetics (2.84 ± 1.25 mL/g/min, P=0.01).
  • MPR showed significant negative correlations with early diastolic strain rate (r=-0.310, P=0.01) and LV torsion (r=-0.306, P=0.01).

Conclusions:

  • Patients with type 2 diabetes demonstrate increased LV mass, LV torsion, and reduced MPR.
  • A significant association between decreased MPR and increased LV torsion suggests a mechanistic link between diabetic microvascular disease and cardiac dysfunction.
Abstract

Keywords:
Cardiovascular magnetic resonanceDiabetesMyocardial perfusion reservePrediabetesStrainTagging

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