Association of obstructive coronary artery disease with left ventricular myocardial energetic efficiency and biventricular dysfunction in T2DM patients: a 3.0T cardiac magnetic resonance study

Biventricular function is a major determinant of clinical outcomes, which should be considered in clinical management and treatment. However, data on biventricular function and left ventricular (LV) indexed myocardial energetic efficiency (MEEI) in type 2 diabetes mellitus (T2DM) patients with or without obstructive coronary artery disease (OCAD) remain limited. This study aimed to assess the associations of documented evidence of OCAD (dOCAD) with LV MEEI and biventricular function in T2DM patients. The study population consisted of 346 T2DM patients {212 without dOCAD [T2DM(dOCAD−)] and 134 with dOCAD [T2DM(dOCAD+)]} and 91 control subjects. Cardiovascular magnetic resonance derived parameters, including biventricular structure, function, global myocardial strain [including peak strain (PS) in longitudinal, circumferential, and radial directions], interventricular septal (IVS) strain, and LV MEEI were measured and compared among observed groups. Univariable and multivariable regression analyses were conducted to evaluate the associations of dOCAD with biventricular global PS and LV MEEI, as well as the relationship between the two ventricles. Compared with the control group, T2DM patients exhibited reduced LV MEEI irrespective of dOCAD status, and the reduction was more marked in those with coexisting dOCAD than in those without (all P < 0.05). Biventricular global PS and IVS strain in longitudinal, circumferential, and radial directions decreased progressively from control subjects to T2DM(dOCAD−) patients, and further to T2DM(dOCAD+) patients (all P < 0.05), except for the global radial PS (GRPS) of the right ventricle (RV). The dOCAD was significantly correlated with impaired LV and RV GRPS (β = −0.26 and − 0.13), GCPS (β = −0.25 and − 0.12), GLPS (β = −0.26 and − 0.16), and LV MEEI (β = −0.15) in the context of T2DM (all P < 0.05). Multivariate regression analysis showed correlations between the RV’s global PS and specific LV global PS in T2DM patients, regardless of dOCAD status (all P < 0.05). In the context of T2DM, dOCAD was associated with impaired LV MEEI and biventricular dysfunction. Meanwhile, biventricular global strain correlations were observed in T2DM patients regardless of dOCAD status.