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Objectives <p>To use cardiac magnetic resonance (CMR) to quantify coronary microvascular function, explore the relationship between perfusion and fibrosis, and assess the impact of coronary microvascular dysfunction (CMD) on adverse clinical outcomes.</p> Materials and methods <p>In a prospective, observational study, patients with type 2 diabetes mellitus (T2DM) and heart failure were recruited alongside control subjects. Participants underwent clinical assessment and CMR, which included T1 mapping, extracellular volume mapping, as well as measurement of myocardial blood flow at rest and during maximal hyperaemia. Primary outcomes were all-cause death or hospitalization with a cardiovascular cause.</p> Results <p>Of 202 participants included, 55 T2DM patients were categorized as heart failure with preserved ejection fraction (DM-HFpEF), 70 as heart failure with ejection fraction less than 50% (DM-HFrEF/HFmrEF), 42 as T2DM control subjects (DM-control) and 35 as asymptomatic control group. DM-HFpEF group exhibited a comparatively diminished myocardial perfusion reserve (MPR) than other three cohorts (all <i>p</i> &lt; 0.05). Reduced MPR (&lt; 2.0) was present in 81.82% of patients with DM-HFpEF. MPR was associated with cardiac troponin T and diffuse fibrosis. MPR demonstrated independent predictability of adverse outcomes even adjusting for clinical, blood, and imaging parameters. Patients with lower MPR exhibited a higher risk of adverse outcomes.</p> Conclusions <p>In symptomatic patients with T2DM, a high prevalence of impaired MPR was observed specifically in individuals with HFpEF. MPR was associated with markers of myocardial injury and fibrosis and was predictive of adverse clinical outcomes. These findings could help identify high-risk patients, leading to more intensive treatment.</p> Key Points <p><Emphasis Type="BoldItalic">Question</Emphasis> <i>Data on cardiac MRI for quantifying myocardial blood flow in diabetic patients with heart failure with preserved ejection fraction are limited.</i></p> <p><Emphasis Type="BoldItalic">Findings</Emphasis> <i>A markedly impaired myocardial perfusion reserve was observed in diabetic patients with heart failure with preserved ejection fraction.</i></p> <p><Emphasis Type="BoldItalic">Clinical relevance</Emphasis> <i>Myocardial blood flow could provide incremental value in the diagnosis and risk stratification in diabetic patients with heart failure with preserved ejection fraction.</i></p> Graphical Abstract <p></p>

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Prevalence and prognostic significance of reduced myocardial perfusion reserve in diabetic heart failure with preserved ejection fraction using quantitative perfusion cardiac magnetic resonance

  • 期刊论文

  • 发表日期：

    2025年3月5日

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  • Yang Yang,
  • Donglu Qin,
  • Chenyu Li,
  • Leting Tang,
  • Shuai Wang,
  • Xiaoman Chen,
  • Daoquan Peng,
  • Mu Zeng,
  • Bilian Yu

摘要

Objectives

To use cardiac magnetic resonance (CMR) to quantify coronary microvascular function, explore the relationship between perfusion and fibrosis, and assess the impact of coronary microvascular dysfunction (CMD) on adverse clinical outcomes.

Materials and methods

In a prospective, observational study, patients with type 2 diabetes mellitus (T2DM) and heart failure were recruited alongside control subjects. Participants underwent clinical assessment and CMR, which included T1 mapping, extracellular volume mapping, as well as measurement of myocardial blood flow at rest and during maximal hyperaemia. Primary outcomes were all-cause death or hospitalization with a cardiovascular cause.

Results

Of 202 participants included, 55 T2DM patients were categorized as heart failure with preserved ejection fraction (DM-HFpEF), 70 as heart failure with ejection fraction less than 50% (DM-HFrEF/HFmrEF), 42 as T2DM control subjects (DM-control) and 35 as asymptomatic control group. DM-HFpEF group exhibited a comparatively diminished myocardial perfusion reserve (MPR) than other three cohorts (all p < 0.05). Reduced MPR (< 2.0) was present in 81.82% of patients with DM-HFpEF. MPR was associated with cardiac troponin T and diffuse fibrosis. MPR demonstrated independent predictability of adverse outcomes even adjusting for clinical, blood, and imaging parameters. Patients with lower MPR exhibited a higher risk of adverse outcomes.

Conclusions

In symptomatic patients with T2DM, a high prevalence of impaired MPR was observed specifically in individuals with HFpEF. MPR was associated with markers of myocardial injury and fibrosis and was predictive of adverse clinical outcomes. These findings could help identify high-risk patients, leading to more intensive treatment.

Key Points

Question Data on cardiac MRI for quantifying myocardial blood flow in diabetic patients with heart failure with preserved ejection fraction are limited.

Findings A markedly impaired myocardial perfusion reserve was observed in diabetic patients with heart failure with preserved ejection fraction.

Clinical relevance Myocardial blood flow could provide incremental value in the diagnosis and risk stratification in diabetic patients with heart failure with preserved ejection fraction.

Graphical Abstract