Cardiac Magnetic Resonance Myocardial Feature Tracking for Optimized Risk Assessment After Acute Myocardial Infarction in Patients With Type 2 Diabetes
| Autor: | Torben Lange, Alexander Koschalka, Joachim Lotz, Andreas Schuster, Matthias Gutberlet, Ingo Eitel, Johannes T. Kowallick, Ruben Evertz, Gerd Hasenfuß, Holger Thiele, Shelby Kutty, Sören J. Backhaus, Thomas Stiermaier, J L Navarra |
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| Rok vydání: | 2020 |
| Předmět: |
0301 basic medicine
Male medicine.medical_specialty Endocrinology Diabetes and Metabolism Myocardial Infarction 030209 endocrinology & metabolism Type 2 diabetes Risk Assessment Ventricular Function Left 03 medical and health sciences 0302 clinical medicine Internal medicine Diabetes mellitus Edema Internal Medicine Medicine Humans cardiovascular diseases Myocardial infarction Aged Ejection fraction medicine.diagnostic_test business.industry Magnetic resonance imaging Heart Middle Aged medicine.disease Magnetic Resonance Imaging 3. Good health 030104 developmental biology Diabetes Mellitus Type 2 cardiovascular system Cardiology Myocardial infarction complications Female medicine.symptom business Mace |
| Zdroj: | Diabetes. 69(7) |
| ISSN: | 1939-327X |
| Popis: | Type 2 diabetes predicts outcome following acute myocardial infarction (AMI). Since underlying mechanics are incompletely understood, we investigated left ventricular (LV) and left atrial (LA) pathophysiological changes and their prognostic implications using cardiovascular magnetic resonance (CMR). Consecutive patients (N = 1,147; n = 265 with diabetes, n = 882 without diabetes) underwent CMR 3 days after AMI. Analyses included LV ejection fraction (LVEF); global longitudinal strain (GLS) and circumferential and radial strains; LA reservoir, conduit, and booster pump strains; and infarct size, edema, and microvascular obstruction. Predefined end points were major adverse cardiovascular events (MACE) within 12 months. Patients with diabetes had impaired LA reservoir (19.8% vs. 21.2%, P < 0.01) and conduit (7.6% vs. 9.0%, P < 0.01) strains but not ventricular function or myocardial damage. They were at higher risk of MACE than patients without diabetes (10.2% vs. 5.8%, P < 0.01), with most MACE occurring in patients with LVEF ≥35%. While LVEF (P = 0.045) and atrial reservoir strain (P = 0.024) were independent predictors of MACE in patients without diabetes, GLS was in patients with diabetes (P = 0.010). Considering patients with diabetes and LVEF ≥35% (n = 237), GLS and LA reservoir strain below median were significantly associated with MACE. In conclusion, in patients with diabetes, LA and LV longitudinal strain permit optimized risk assessment early after reperfused AMI with incremental prognostic value over and above that of LVEF. |
| Databáze: | OpenAIRE |
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