Occult coronary microvascular dysfunction and ischemic heart disease in patients with diabetes and heart failure
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 re...
Saved in:
| Main Authors: | , , , , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2024-01-01
|
| Series: | Journal of Cardiovascular Magnetic Resonance |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S1097664724011001 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1850255973924470784 |
|---|---|
| author | Noor Sharrack Louise A.E. Brown Jonathan Farley Ali Wahab Nicholas Jex Sharmaine Thirunavukarasu Amrit Chowdhary Miroslawa Gorecka Wasim Javed Hui Xue Eylem Levelt Erica Dall’Armellina Peter Kellman Pankaj Garg John P. Greenwood Sven Plein Peter P. Swoboda |
| author_facet | Noor Sharrack Louise A.E. Brown Jonathan Farley Ali Wahab Nicholas Jex Sharmaine Thirunavukarasu Amrit Chowdhary Miroslawa Gorecka Wasim Javed Hui Xue Eylem Levelt Erica Dall’Armellina Peter Kellman Pankaj Garg John P. Greenwood Sven Plein Peter P. Swoboda |
| author_sort | Noor Sharrack |
| collection | DOAJ |
| description | 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. |
| format | Article |
| id | doaj-art-a7b08bf7a76d4a7ba053c0149dada29e |
| institution | OA Journals |
| issn | 1097-6647 |
| language | English |
| publishDate | 2024-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of Cardiovascular Magnetic Resonance |
| spelling | doaj-art-a7b08bf7a76d4a7ba053c0149dada29e2025-08-20T01:56:45ZengElsevierJournal of Cardiovascular Magnetic Resonance1097-66472024-01-0126210107310.1016/j.jocmr.2024.101073Occult coronary microvascular dysfunction and ischemic heart disease in patients with diabetes and heart failureNoor Sharrack0Louise A.E. Brown1Jonathan Farley2Ali Wahab3Nicholas Jex4Sharmaine Thirunavukarasu5Amrit Chowdhary6Miroslawa Gorecka7Wasim Javed8Hui Xue9Eylem Levelt10Erica Dall’Armellina11Peter Kellman12Pankaj Garg13John P. Greenwood14Sven Plein15Peter P. Swoboda16Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UKLeeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UKLeeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UKLeeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UKLeeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UKLeeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UKLeeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UKLeeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UKLeeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UKNational Heart, Lung and Blood Institute, Bethesda, Maryland, USALeeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UKLeeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UKNational Heart, Lung and Blood Institute, Bethesda, Maryland, USACardiovascular and Metabolic Medicine Group, Norwich Medical School, University of East Anglia, Norwich, UKLeeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UKLeeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UKLeeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK; Corresponding author. Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, 6 Clarendon Way, Leeds LS2 9NL, UK.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.http://www.sciencedirect.com/science/article/pii/S1097664724011001Cardiovascular magnetic resonance (CMR)Coronary microvascular dysfunction (CMD)Diabetes mellitus (DM)Heart failure (HF)Myocardial blood flow (MBF)Myocardial perfusion reserve (MPR) |
| spellingShingle | Noor Sharrack Louise A.E. Brown Jonathan Farley Ali Wahab Nicholas Jex Sharmaine Thirunavukarasu Amrit Chowdhary Miroslawa Gorecka Wasim Javed Hui Xue Eylem Levelt Erica Dall’Armellina Peter Kellman Pankaj Garg John P. Greenwood Sven Plein Peter P. Swoboda Occult coronary microvascular dysfunction and ischemic heart disease in patients with diabetes and heart failure Journal of Cardiovascular Magnetic Resonance Cardiovascular magnetic resonance (CMR) Coronary microvascular dysfunction (CMD) Diabetes mellitus (DM) Heart failure (HF) Myocardial blood flow (MBF) Myocardial perfusion reserve (MPR) |
| title | Occult coronary microvascular dysfunction and ischemic heart disease in patients with diabetes and heart failure |
| title_full | Occult coronary microvascular dysfunction and ischemic heart disease in patients with diabetes and heart failure |
| title_fullStr | Occult coronary microvascular dysfunction and ischemic heart disease in patients with diabetes and heart failure |
| title_full_unstemmed | Occult coronary microvascular dysfunction and ischemic heart disease in patients with diabetes and heart failure |
| title_short | Occult coronary microvascular dysfunction and ischemic heart disease in patients with diabetes and heart failure |
| title_sort | occult coronary microvascular dysfunction and ischemic heart disease in patients with diabetes and heart failure |
| topic | Cardiovascular magnetic resonance (CMR) Coronary microvascular dysfunction (CMD) Diabetes mellitus (DM) Heart failure (HF) Myocardial blood flow (MBF) Myocardial perfusion reserve (MPR) |
| url | http://www.sciencedirect.com/science/article/pii/S1097664724011001 |
| work_keys_str_mv | AT noorsharrack occultcoronarymicrovasculardysfunctionandischemicheartdiseaseinpatientswithdiabetesandheartfailure AT louiseaebrown occultcoronarymicrovasculardysfunctionandischemicheartdiseaseinpatientswithdiabetesandheartfailure AT jonathanfarley occultcoronarymicrovasculardysfunctionandischemicheartdiseaseinpatientswithdiabetesandheartfailure AT aliwahab occultcoronarymicrovasculardysfunctionandischemicheartdiseaseinpatientswithdiabetesandheartfailure AT nicholasjex occultcoronarymicrovasculardysfunctionandischemicheartdiseaseinpatientswithdiabetesandheartfailure AT sharmainethirunavukarasu occultcoronarymicrovasculardysfunctionandischemicheartdiseaseinpatientswithdiabetesandheartfailure AT amritchowdhary occultcoronarymicrovasculardysfunctionandischemicheartdiseaseinpatientswithdiabetesandheartfailure AT miroslawagorecka occultcoronarymicrovasculardysfunctionandischemicheartdiseaseinpatientswithdiabetesandheartfailure AT wasimjaved occultcoronarymicrovasculardysfunctionandischemicheartdiseaseinpatientswithdiabetesandheartfailure AT huixue occultcoronarymicrovasculardysfunctionandischemicheartdiseaseinpatientswithdiabetesandheartfailure AT eylemlevelt occultcoronarymicrovasculardysfunctionandischemicheartdiseaseinpatientswithdiabetesandheartfailure AT ericadallarmellina occultcoronarymicrovasculardysfunctionandischemicheartdiseaseinpatientswithdiabetesandheartfailure AT peterkellman occultcoronarymicrovasculardysfunctionandischemicheartdiseaseinpatientswithdiabetesandheartfailure AT pankajgarg occultcoronarymicrovasculardysfunctionandischemicheartdiseaseinpatientswithdiabetesandheartfailure AT johnpgreenwood occultcoronarymicrovasculardysfunctionandischemicheartdiseaseinpatientswithdiabetesandheartfailure AT svenplein occultcoronarymicrovasculardysfunctionandischemicheartdiseaseinpatientswithdiabetesandheartfailure AT peterpswoboda occultcoronarymicrovasculardysfunctionandischemicheartdiseaseinpatientswithdiabetesandheartfailure |