Traditional CV risk factors best predict cardiomyopathy in type 1 diabetes
medwireNews: Traditional cardiovascular (CV) risk factors are the strongest indicators of early subclinical cardiac dysfunction in patients with type 1 diabetes, study findings indicate.
“The presence of myocardial scar, although infrequent, may also play a role in the cardiac dysfunction of this population, particularly in the presence of a nonischemic pattern,” João Lima (Johns Hopkins University, Baltimore, Maryland, USA) and co-authors report in Diabetes Care.
The researchers analysed cardiac magnetic resonance (CMR) images obtained from 714 patients with type 1 diabetes for ischemic and nonischemic scars and circumferential strain.
All patients had more than 2 decades of follow-up data as participants of the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications study, and had a mean age of 49 years and a mean duration of type 1 diabetes of 28 years.
Lima and team report that circumferential deformation was significantly worse (less-negative Ecc values) in participants who were male, aged 50 years or older, smokers, and obese, and in those with hypertension, hypercholesterolemia, the metabolic syndrome, proliferative diabetic retinopathy, impaired renal function, and higher mean glycated hemoglobin.
They also found that participants with nonischemic scars (n=32) had significantly worse circumferential function than with those without scars. However, interstitial fibrosis, as measured by postcontrast T1 times, was not associated with circumferential strain.
“Nonischemic scar is a probable indicator of advanced stages of diffuse disease and a possible indicator of relevant cardiac damage seen in pre-clinical phases of [diabetic cardiomyopathy],” Lima et al explain.
They add that the relationship was substantially attenuated when adjusting for clinical risk factors, which suggests “that the relationship between myocardial scar and cardiac dysfunction may be mediated by chronic exposure to known risk factors.”
The researchers also report that left ventricular ejection fraction was not associated with any of the clinical risk factors studied, but was significantly lower if a myocardial scar was present.
They conclude: “The findings indicate that known risk factors of cardiovascular outcomes in the general population similarly affect early cardiac dysfunction in type 1 diabetes and support approaches for primary prevention of [cardiovascular disease] in this population.”
By Laura Cowen
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