期刊
EUROPEAN HEART JOURNAL
卷 35, 期 10, 页码 657-664出版社
OXFORD UNIV PRESS
DOI: 10.1093/eurheartj/eht193
关键词
MRI; extracellular matrix; fibrosis; collagen; diabetes; extracellular volume fraction
资金
- Pittsburgh Foundation [M2009-0068]
- American Heart Association Scientist Development [09SDG2180083]
- Atlantic Philanthropies, Inc.
- John A. Hartford Foundation
- American Heart Association
- Agency for Healthcare Research and Quality [K12 HS19461-01]
- McGinnis Endowed Chair funds
- National Center for Research Resources (NCRR) [UL1 RR024153]
- National Institutes of Health (NIH)
- NIH Roadmap for Medical Research
- Association of Specialty Professors
Aims Diabetes may promote myocardial extracellular matrix (ECM) expansion that increases vulnerability. We hypothesized that: (i) type 2 diabetes would be associated with quantitative cardiovascular magnetic resonance (CMR) measures of myocardial ECM expansion, i. e. extracellular volume fraction (ECV); (ii) medications blocking the renin-angiotensin-aldosterone system (RAAS) would be associated with lower ECV; and (iii) ECV in diabetic individuals would be associated with mortality and/or incident hospitalization for heart failure. Methods and results We enrolled 1176 consecutive patients referred for CMR without amyloidosis and computed ECV from measures of the haematocrit and myocardial and blood T1 pre- and post-contrast. Linear regression modelled ECV; Cox regression modelled mortality and/or hospitalization for heart failure. Diabetic individuals (n = 231) had higher median ECV than those without diabetes (n = 945): 30.2% (IQR: 26.9-32.7) vs. 28.1% (IQR: 25.9-31.0), respectively, P < 0.001). Diabetes remained associated with higher ECV in models adjusting for demographics, comorbidities, and medications (P < 0.001). Renin-angiotensin-aldosterone system blockade was associated with lower ECV (P = 0.028) in multivariable linear models. Over a median of 1.3 years (IQR: 0.8-1.9), 38 diabetic individuals had events (21 incident hospitalizations for heart failure; 24 deaths), and ECV was associated with these events (HR: 1.52, 95% CI: 1.21-1.89 per 3% ECV increase) in multivariable Cox regression models. Conclusion Diabetes is associated with increased ECV. Extracellular volume fraction detects amelioration of ECM expansion associated with RAAS blockade, and is associated with mortality and/or incident hospitalization for heart failure in diabetic individuals. Extracellular matrix expansion may be an important intermediate phenotype in diabetic individuals that is detectable and treatable.
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