Abstract：
BACKGROUND: Patients with diabetes (DM) and heart failure (HF) have worse outcomes than normoglycaemic HF patients. Cardiovascular magnetic resonance (CMR) can identify ischaemic heart disease (IHD) and quantify coronary microvascular dysfunction (CMD) using myocardial perfusion reserve (MPR). We aimed to quantify extent of silent IHD and CMD in patients with DM presenting with HF.
METHODS: Prospectively recruited outpatients undergoing assessment into the aetiology of HF underwent inline 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 normoglycaemic, 84 with pre-diabetes and 83 with DM). Prevalence of silent IHD was highest in DM (31%), then pre-diabetes (20%) then normoglycaemia (17%). Stress MBF was lowest in DM (1.53±0.52), then pre-diabetes (1.59±0.54) then normoglycaemia (1.83±0.62). MPR was lowest in DM (2.37±0.85) then pre-diabetes (2.41±0.88) then normoglycaemia (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.
CONCLUSIONS: 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 assessment of silent IHD and CMD in patients with DM presenting with HF.
METHODS: Prospectively recruited outpatients undergoing assessment into the aetiology of HF underwent inline 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 normoglycaemic, 84 with pre-diabetes and 83 with DM). Prevalence of silent IHD was highest in DM (31%), then pre-diabetes (20%) then normoglycaemia (17%). Stress MBF was lowest in DM (1.53±0.52), then pre-diabetes (1.59±0.54) then normoglycaemia (1.83±0.62). MPR was lowest in DM (2.37±0.85) then pre-diabetes (2.41±0.88) then normoglycaemia (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.
CONCLUSIONS: 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 assessment of silent IHD and CMD in patients with DM presenting with HF.
摘要：
背景：糖尿病（DM）和心力衰竭（HF）患者的预后比血糖正常的HF患者差。心血管磁共振（CMR）可以使用心肌灌注储备（MPR）识别缺血性心脏病（IHD）并量化冠状动脉微血管功能障碍（CMD）。我们旨在量化表现为HF的DM患者中沉默IHD和CMD的程度。
方法：前瞻性招募接受HF病因评估的门诊患者，接受内联定量灌注CMR，以计算压力和静息心肌血流量（MBF）和MPR。排除包括心绞痛或IHD病史。对患者的主要不良心血管事件（MACE）进行随访（中位3.0年）。
结果：最终分析包括343例患者（176例血糖正常，84患有糖尿病前期，83患有DM）。沉默IHD的患病率在DM中最高（31％），然后是糖尿病前期（20％），然后是血糖正常（17％）。DM应力MBF最低(1.53±0.52),然后是糖尿病前期（1.59±0.54），然后是血糖正常（1.83±0.62）。MPR在DM中最低（2.37±0.85），然后是糖尿病前期（2.41±0.88），然后是血糖正常（2.61±0.90）。在随访期间，45例患者经历了至少一次MACE。在单变量Cox回归分析中，MPR和沉默IHD的存在均与MACE相关。然而,HbA1c校正后，年龄和左心室射血分数之间的关联不再显著.
结论：DM和HF患者无症状IHD的患病率较高，与非糖尿病患者相比，CMD的证据更多，心血管结局更差。这些发现强调了CMR对于评估患有HF的DM患者的沉默IHD和CMD的潜在价值。
方法：前瞻性招募接受HF病因评估的门诊患者，接受内联定量灌注CMR，以计算压力和静息心肌血流量（MBF）和MPR。排除包括心绞痛或IHD病史。对患者的主要不良心血管事件（MACE）进行随访（中位3.0年）。
结果：最终分析包括343例患者（176例血糖正常，84患有糖尿病前期，83患有DM）。沉默IHD的患病率在DM中最高（31％），然后是糖尿病前期（20％），然后是血糖正常（17％）。DM应力MBF最低(1.53±0.52),然后是糖尿病前期（1.59±0.54），然后是血糖正常（1.83±0.62）。MPR在DM中最低（2.37±0.85），然后是糖尿病前期（2.41±0.88），然后是血糖正常（2.61±0.90）。在随访期间，45例患者经历了至少一次MACE。在单变量Cox回归分析中，MPR和沉默IHD的存在均与MACE相关。然而,HbA1c校正后，年龄和左心室射血分数之间的关联不再显著.
结论：DM和HF患者无症状IHD的患病率较高，与非糖尿病患者相比，CMD的证据更多，心血管结局更差。这些发现强调了CMR对于评估患有HF的DM患者的沉默IHD和CMD的潜在价值。
