Type 2 diabetes and high myocardial extracellular volume fraction independently increased the risk of adverse cardiovascular outcomes, with T2D associated with an adjusted HR of 2.76.
Cohort (n=739)
No
Does the presence of Type 2 diabetes and high myocardial extracellular volume fraction predict adverse cardiovascular outcomes in patients with known or suspected coronary artery disease?
In patients with known or suspected coronary artery disease, Type 2 diabetes is associated with higher myocardial ECV, and both T2D and high ECV independently predict adverse cardiovascular events.
Effect estimate: HR 2.76 (95% CI 1.51-5.06)
p-value: p=0.001
Background: To investigate the difference in myocardial extracellular volume fraction (ECV) by cardiac magnetic resonance (CMR) T1 mapping between patients with and without type 2 diabetes (T2D), and the effect of ECV and T2D on cardiovascular (CV) outcomes. Methods: All patients aged 18 years with known or suspected coronary artery disease who underwent CMR for assessment of myocardial ischemia or myocardial viability at the Department of Cardiology of the Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand from September 2017 to December 2018 were screened for inclusion eligibility. Left ventricular ejection fraction (LVEF), late gadolinium enhancement, and T1 mapping were performed. ECV values were derived from myocardial native T1 and contrast-enhanced T1 values that were obtained using modified Look-Locker inversion recovery at the septum of the mid-cavity short-axis map. Demographic data, clinical characteristics, and CV outcomes were collected by retrospective chart review. Composite CV outcomes included CV death, acute coronary syndrome, heart failure hospitalization, or ventricular tachycardia (VT)/ventricular fibrillation. Results: A total of 739 subjects (mean age: 69.5 ± 14.0 years, 49.3% men) were included. Of those, 188 subjects had T2D (25.4%). ECV was significantly higher in T2D than in non-T2D (30.0 ± 5.9% vs. 28.8 ± 4.7%, p = 0.004). During the mean follow-up duration of 26.2 ± 8.5 months, 43 patients (5.8%) had a clinical composite outcome, as follows: three CV death (0.4%), seven acute coronary syndrome (0.9%), 33 heart failure hospitalization (4.5%), and one VT (0.1%). T2D, low LVEF, and high ECV were all identified as independent predictors of CV events. Patients with T2D and high ECV had the highest risk of CV events. Conclusion: Among patients with known or suspected coronary artery disease, patients with T2D had a higher ECV. T2D and high ECV were both found to be independent risk factors for adverse CV outcomes.
Laohabut et al. (Tue,) conducted a cohort in Known or suspected coronary artery disease (n=739). Type 2 Diabetes vs. Without Type 2 Diabetes was evaluated on Composite of cardiovascular death, acute coronary syndrome, heart failure hospitalization, or ventricular tachycardia/ventricular fibrillation (HR 2.76, 95% CI 1.51-5.06, p=0.001). Type 2 diabetes and high myocardial extracellular volume fraction independently increased the risk of adverse cardiovascular outcomes, with T2D associated with an adjusted HR of 2.76.