Key result
Multi-segment ischemia on stress CMR linked to a ~7-fold increase in MACE risk.
Why the study?
Does stress perfusion CMR predict major adverse cardiovascular events in diabetic patients without known cardiovascular disease?
Cohort (n=2,718)
Yes
Does stress perfusion CMR predict major adverse cardiovascular events in diabetic patients without known cardiovascular disease?
Hazard Ratio: 7.14 (95% CI 5.01–10.02)
p-value: p=<0.001
Stress CMR provides significant prognostic value for predicting MACE in diabetic patients without known cardiovascular disease, performing equally well regardless of symptom status.
Objectives The aim of this study was to evaluate the prognostic value of stress perfusion cardiovascular magnetic resonance (CMR) in diabetic versus non-diabetic patients, and then in symptomatic versus asymptomatic diabetics. Background Diabetic individuals are at increased risk of coronary atherosclerosis. A significant percentage of diabetics fail to perceive the typical symptoms of myocardial ischemia. Screening methods such as coronary computed tomography (CCTA) or single-photon emission computed tomography (SPECT) have not shown clear benefits in asymptomatic diabetics. The role of stress CMR in this population is not well established. Methods Between 2008 and 2018, all consecutive diabetic and non-diabetic patients without known cardiovascular disease referred for stress perfusion CMR in two tertiary centers were included. Propensity-score matching was used to create a cohort of diabetic versus non-diabetic patients with similar baseline characteristics. All patients were followed for the occurrence of major adverse cardiovascular events (MACE), defined as cardiovascular death or non-fatal myocardial infarction. Diabetic patients were categorized into symptomatic and asymptomatic patients. Results Out of 3,485 eligible patients, 1,359 diabetics and 1,359 non-diabetics (mean age 69±12 years, 57.4% women) with similar propensity scores were included. Over a median follow-up period of 6.5 (5.9-8.9) years, 386 (14.2%) experienced MACEs. Kaplan-Meier analysis for the occurrence of MACE indicated that the extent of ischemia or late gadolinium enhancement (LGE) involving ≥ 3 segments were independent predictors of the occurrence of MACEs (hazard ratio, HR: 7.14 [95% CI, 5.01–10.02]; and HR: 5.03 [95% CI, 3.47–7.29]; both p<0.001, respectively), with no significant differences between diabetics and non-diabetics. Asymptomatic diabetics (n=255) showed similar event rates as symptomatic patients (p=0.98). Conclusion Stress CMR provides valuable prognostic information in diabetic patients, irrespective of symptoms. Further assessment is needed to determine whether stress CMR should be a standard screening tool for diabetic patients.
No takes yet. Share an insight, caveat, or question.
Hinderks et al. (2025) conducted a cohort in Diabetes Mellitus (n=2,718). Ischemia involving ≥ 3 segments on stress CMR was evaluated on Major adverse cardiovascular events (MACE), defined as cardiovascular death or non-fatal myocardial infarction (HR 7.14, 95% CI 5.01-10.02, p=<0.001). Ischemia involving ≥ 3 segments on stress CMR strongly predicted major adverse cardiovascular events (HR 7.14; 95% CI 5.01-10.02; p<0.001), similarly in diabetic and non-diabetic patients.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: