Interdependence between myocardial deformation and perfusion in patients with T2DM and heart failure with preserved ejection fraction (HFpEF): a feature-tracking and stress perfusion cardiac magnetic resonance (CMR) study
Authors' conclusion
Patients with T2DM and HFpEF exhibited significant LV systolic and diastolic deformation, decreased LA reservoir strain, severe impairment of myocardial perfusion, and elevated LA booster strain that is a compensatory response in HFpEF. Global MPRI was identified as an independent influencing factor on LA reservoir and LA booster strain. The difference in LA reservoir and LA booster strain between patients with T2DM with and without HFpEF was totally mediated by global MPRI, suggesting a possible mechanistic link between microcirculation impairment and cardiac dysfunction in diabetes. Myocardial perfusion and LA strain may prove valuable for diagnosing and managing HFpEF in the future.
Study context
- Population
- Patients with T2D without obstructive coronary artery disease (CAD) and healthy volunteers undergoing CMR at one centre156 T2D + 50 healthy
- Exposure
- T2D with HFpEF vs T2D without HFpEF vs healthy controls
- Outcome
- LV/LA strain and myocardial perfusion, T2D with vs without HFpEF
Methodological detailssingle-centre, feature-tracking and stress perfusion CMR, mediation analysis
- Single-centre
- Feature-tracking and stress perfusion CMR
- Mediation analysis
Main finding
As reported in the abstract
- Difference in left atrial (LA) reservoir and LA booster strain between T2D with and without HFpEF totally mediated by global myocardial perfusion reserve index (MPRI)
- T2DM-HFpEF vs T2DM-non-HFpEF: all P < 0.05
Observational data: associations, not effects.
Further findings
| Outcome | P value |
|---|---|
| Strain, T2D without HFpEF vs controls | all P < 0.05 |
- Strain, T2D without HFpEF vs controls: impaired left ventricular (LV) longitudinal peak systolic strain rate (PSSR), LA reservoir and LA conduit strain; compensatory LV torsion, LV radial PSSR and LA booster strain
Independent association with global MPRI (multivariate linear regression)
- LA reservoir strain β (P < 0.001)
- 0.259
- LA booster strain β (P < 0.001)
- - 0.326
Diagnostic accuracy for HFpEF among T2D
- Global stress PI AUC
- 0.803
- LA booster AUC
- 0.790
- Global rest PI AUC
- 0.740
- Global MPRI AUC
- 0.740
Parts of this Brief are withheld: the automatic checks could not confirm them against the abstract.
Original publication
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