European heart journal. Cardiovascular Imaging · 2026
The role of stress cardiovascular magnetic resonance in patients with diabetes mellitus.
СтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод пока не подготовлен
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Hinderks Mark, Toupin Solenn, Nijveldt Robin, Duhamel Suzanne, Sanguineti Francesca, Hovasse Thomas, Champagne Stéphane, Unterseeh Thierry, Akodad Myriam, Neylon Antoinette, Gonçalves Trecy, Martial Paul-Jun, Houssany-Pissot Sonia, Gall Emmanuel, Dillinger Jean Guillaume, Henry Patrick, Bousson Valérie, Garot Philippe, Damman Peter, Garot Jérôme, Pezel Théo
Аннотация
AIMS: The aim of this study was to evaluate the prognostic value of stress perfusion cardiovascular magnetic resonance (CMR) in diabetic vs. non-diabetic patients and then in symptomatic vs. asymptomatic diabetics. Diabetic individuals are at increased risk of coronary atherosclerosis. A significant percentage of diabetics fail to perceive the typical symptoms of myocardial ischaemia. Screening methods such as coronary computed tomography angiography (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 AND RESULTS: Between 2008 and 2018, all consecutive diabetic and non-diabetic patients without known cardiovascular disease referred for stress perfusion CMR in two tertiary centres were included. Propensity score matching was used to create a cohort of diabetic vs. 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. Out of 3485 eligible patients, 1359 diabetics and 1359 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 ischaemia or late gadolinium enhancement involving ≥3 segments were independent predictors of the occurrence of MACEs {hazard ratio [HR]: 7.14 [95% confidence interval (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.
METHODS AND RESULTS: Between 2008 and 2018, all consecutive diabetic and non-diabetic patients without known cardiovascular disease referred for stress perfusion CMR in two tertiary centres were included. Propensity score matching was used to create a cohort of diabetic vs. 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. Out of 3485 eligible patients, 1359 diabetics and 1359 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 ischaemia or late gadolinium enhancement involving ≥3 segments were independent predictors of the occurrence of MACEs {hazard ratio [HR]: 7.14 [95% confidence interval (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.