Diabetes mellitus in patients with heart failure was associated with a higher prevalence of silent ischemic heart disease (31% vs 17% in normoglycemia) and lower myocardial perfusion reserve.
Cohort (n=343)
Does diabetes mellitus increase the prevalence of occult coronary microvascular dysfunction and silent ischemic heart disease in patients presenting with heart failure?
In patients with heart failure, diabetes is associated with a higher prevalence of silent ischemic heart disease and coronary microvascular dysfunction on CMR, though these imaging findings did not independently predict MACE after adjusting for age, LVEF, and HbA1c.
Absolute Event Rate: 31% vs 17%
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.
Sharrack et al. (Mon,) conducted a cohort in Heart failure (n=343). Diabetes mellitus vs. Normoglycemia and pre-diabetes was evaluated on Prevalence of silent ischemic heart disease (IHD). Diabetes mellitus in patients with heart failure was associated with a higher prevalence of silent ischemic heart disease (31% vs 17% in normoglycemia) and lower myocardial perfusion reserve.