Myocardial structure, function, and scar in patients with type 1 diabetes mellitus

Evrim B. Turkbey; Jye Yu C. Backlund; Saul Genuth; Aditya Jain; Cuilian Miao; Patricia A. Cleary; John M. Lachin; David M. Nathan; Rob J. Van Der Geest; Elsayed Z. Soliman; Chia Ying Liu; João A.C. Lima; David A. Bluemke

doi:10.1161/CIRCULATIONAHA.111.022327

Myocardial structure, function, and scar in patients with type 1 diabetes mellitus

Evrim B. Turkbey, Jye Yu C. Backlund, Saul Genuth, Aditya Jain, Cuilian Miao, Patricia A. Cleary, John M. Lachin, David M. Nathan, Rob J. Van Der Geest, Elsayed Z. Soliman, Chia Ying Liu, João A.C. Lima, David A. Bluemke

School of Medicine

Research output: Contribution to journal › Article › peer-review

58 Scopus citations

Abstract

BACKGROUND-: We report relationships between cardiovascular disease risk factors and myocardial structure, function, and scar in patients with type 1 diabetes mellitus in the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) study. METHODS AND RESULTS-: Cardiac magnetic resonance was obtained in 1017 patients with type 1 diabetes mellitus. Gadolinium cardiac magnetic resonance was also obtained in 741 patients. The mean age was 49±7 years; 52% were men; and mean duration of diabetes mellitus was 28±5 years. Associations of cardiovascular disease risk factors with cardiac magnetic resonance parameters were examined with linear and logistic regression models. History of macroalbuminuria was positively associated with left ventricular mass (by 14.8 g), leading to a significantly higher ratio of left ventricular mass to end-diastolic volume (by 8%). Mean hemoglobin A1c levels over the preceding 22 years were inversely associated with end-diastolic volume (-3.0 mL per unit mean hemoglobin A1c percent) and stroke volume (-2.3 mL per unit mean hemoglobin A1c percent) and positively related to the ratio of elevated left ventricular mass to end-diastolic volume (0.02 g/mL per unit). The overall prevalence of myocardial scar was 4.3% by cardiac magnetic resonance and 1.4% by clinical adjudication of myocardial infarction. Both mean hemoglobin A1c (odds ratio, 1.5 [95% confidence interval, 1.0-2.2] per unit) and macroalbuminuria (odds ratio, 3.5 [95% confidence interval, 1.2-9.9]) were significantly associated with myocardial scar and traditional cardiovascular disease risk factors. CONCLUSIONS-: In addition to traditional cardiovascular disease risk factors, elevated mean hemoglobin A1c and macroalbuminuria were significantly associated with alterations in left ventricular structure and function. The prevalence of myocardial scar was 4.3% in this subcohort of DCCT/EDIC participants with relatively preserved renal function.

Original language	English (US)
Pages (from-to)	1737-1746
Number of pages	10
Journal	Circulation
Volume	124
Issue number	16
DOIs	https://doi.org/10.1161/CIRCULATIONAHA.111.022327
State	Published - Oct 18 2011

ASJC Scopus subject areas

Cardiology and Cardiovascular Medicine
Physiology (medical)

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10.1161/CIRCULATIONAHA.111.022327

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Turkbey, E. B., Backlund, J. Y. C., Genuth, S., Jain, A., Miao, C., Cleary, P. A., Lachin, J. M., Nathan, D. M., Van Der Geest, R. J., Soliman, E. Z., Liu, C. Y., Lima, J. A. C., & Bluemke, D. A. (2011). Myocardial structure, function, and scar in patients with type 1 diabetes mellitus. Circulation, 124(16), 1737-1746. https://doi.org/10.1161/CIRCULATIONAHA.111.022327

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title = "Myocardial structure, function, and scar in patients with type 1 diabetes mellitus",

abstract = "BACKGROUND-: We report relationships between cardiovascular disease risk factors and myocardial structure, function, and scar in patients with type 1 diabetes mellitus in the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) study. METHODS AND RESULTS-: Cardiac magnetic resonance was obtained in 1017 patients with type 1 diabetes mellitus. Gadolinium cardiac magnetic resonance was also obtained in 741 patients. The mean age was 49±7 years; 52% were men; and mean duration of diabetes mellitus was 28±5 years. Associations of cardiovascular disease risk factors with cardiac magnetic resonance parameters were examined with linear and logistic regression models. History of macroalbuminuria was positively associated with left ventricular mass (by 14.8 g), leading to a significantly higher ratio of left ventricular mass to end-diastolic volume (by 8%). Mean hemoglobin A1c levels over the preceding 22 years were inversely associated with end-diastolic volume (-3.0 mL per unit mean hemoglobin A1c percent) and stroke volume (-2.3 mL per unit mean hemoglobin A1c percent) and positively related to the ratio of elevated left ventricular mass to end-diastolic volume (0.02 g/mL per unit). The overall prevalence of myocardial scar was 4.3% by cardiac magnetic resonance and 1.4% by clinical adjudication of myocardial infarction. Both mean hemoglobin A1c (odds ratio, 1.5 [95% confidence interval, 1.0-2.2] per unit) and macroalbuminuria (odds ratio, 3.5 [95% confidence interval, 1.2-9.9]) were significantly associated with myocardial scar and traditional cardiovascular disease risk factors. CONCLUSIONS-: In addition to traditional cardiovascular disease risk factors, elevated mean hemoglobin A1c and macroalbuminuria were significantly associated with alterations in left ventricular structure and function. The prevalence of myocardial scar was 4.3% in this subcohort of DCCT/EDIC participants with relatively preserved renal function.",

author = "Turkbey, {Evrim B.} and Backlund, {Jye Yu C.} and Saul Genuth and Aditya Jain and Cuilian Miao and Cleary, {Patricia A.} and Lachin, {John M.} and Nathan, {David M.} and {Van Der Geest}, {Rob J.} and Soliman, {Elsayed Z.} and Liu, {Chia Ying} and Lima, {Jo{\~a}o A.C.} and Bluemke, {David A.}",

year = "2011",

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day = "18",

doi = "10.1161/CIRCULATIONAHA.111.022327",

language = "English (US)",

volume = "124",

pages = "1737--1746",

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T1 - Myocardial structure, function, and scar in patients with type 1 diabetes mellitus

AU - Turkbey, Evrim B.

AU - Backlund, Jye Yu C.

AU - Genuth, Saul

AU - Jain, Aditya

AU - Miao, Cuilian

AU - Cleary, Patricia A.

AU - Lachin, John M.

AU - Nathan, David M.

AU - Van Der Geest, Rob J.

AU - Soliman, Elsayed Z.

AU - Liu, Chia Ying

AU - Lima, João A.C.

AU - Bluemke, David A.

PY - 2011/10/18

Y1 - 2011/10/18

N2 - BACKGROUND-: We report relationships between cardiovascular disease risk factors and myocardial structure, function, and scar in patients with type 1 diabetes mellitus in the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) study. METHODS AND RESULTS-: Cardiac magnetic resonance was obtained in 1017 patients with type 1 diabetes mellitus. Gadolinium cardiac magnetic resonance was also obtained in 741 patients. The mean age was 49±7 years; 52% were men; and mean duration of diabetes mellitus was 28±5 years. Associations of cardiovascular disease risk factors with cardiac magnetic resonance parameters were examined with linear and logistic regression models. History of macroalbuminuria was positively associated with left ventricular mass (by 14.8 g), leading to a significantly higher ratio of left ventricular mass to end-diastolic volume (by 8%). Mean hemoglobin A1c levels over the preceding 22 years were inversely associated with end-diastolic volume (-3.0 mL per unit mean hemoglobin A1c percent) and stroke volume (-2.3 mL per unit mean hemoglobin A1c percent) and positively related to the ratio of elevated left ventricular mass to end-diastolic volume (0.02 g/mL per unit). The overall prevalence of myocardial scar was 4.3% by cardiac magnetic resonance and 1.4% by clinical adjudication of myocardial infarction. Both mean hemoglobin A1c (odds ratio, 1.5 [95% confidence interval, 1.0-2.2] per unit) and macroalbuminuria (odds ratio, 3.5 [95% confidence interval, 1.2-9.9]) were significantly associated with myocardial scar and traditional cardiovascular disease risk factors. CONCLUSIONS-: In addition to traditional cardiovascular disease risk factors, elevated mean hemoglobin A1c and macroalbuminuria were significantly associated with alterations in left ventricular structure and function. The prevalence of myocardial scar was 4.3% in this subcohort of DCCT/EDIC participants with relatively preserved renal function.

AB - BACKGROUND-: We report relationships between cardiovascular disease risk factors and myocardial structure, function, and scar in patients with type 1 diabetes mellitus in the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) study. METHODS AND RESULTS-: Cardiac magnetic resonance was obtained in 1017 patients with type 1 diabetes mellitus. Gadolinium cardiac magnetic resonance was also obtained in 741 patients. The mean age was 49±7 years; 52% were men; and mean duration of diabetes mellitus was 28±5 years. Associations of cardiovascular disease risk factors with cardiac magnetic resonance parameters were examined with linear and logistic regression models. History of macroalbuminuria was positively associated with left ventricular mass (by 14.8 g), leading to a significantly higher ratio of left ventricular mass to end-diastolic volume (by 8%). Mean hemoglobin A1c levels over the preceding 22 years were inversely associated with end-diastolic volume (-3.0 mL per unit mean hemoglobin A1c percent) and stroke volume (-2.3 mL per unit mean hemoglobin A1c percent) and positively related to the ratio of elevated left ventricular mass to end-diastolic volume (0.02 g/mL per unit). The overall prevalence of myocardial scar was 4.3% by cardiac magnetic resonance and 1.4% by clinical adjudication of myocardial infarction. Both mean hemoglobin A1c (odds ratio, 1.5 [95% confidence interval, 1.0-2.2] per unit) and macroalbuminuria (odds ratio, 3.5 [95% confidence interval, 1.2-9.9]) were significantly associated with myocardial scar and traditional cardiovascular disease risk factors. CONCLUSIONS-: In addition to traditional cardiovascular disease risk factors, elevated mean hemoglobin A1c and macroalbuminuria were significantly associated with alterations in left ventricular structure and function. The prevalence of myocardial scar was 4.3% in this subcohort of DCCT/EDIC participants with relatively preserved renal function.

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Myocardial structure, function, and scar in patients with type 1 diabetes mellitus

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