PMID- 29070069 OWN - NLM STAT- MEDLINE DCOM- 20180716 LR - 20240117 IS - 1532-429X (Electronic) IS - 1097-6647 (Print) IS - 1097-6647 (Linking) VI - 19 IP - 1 DP - 2017 Oct 25 TI - Adenosine stress CMR T1-mapping detects early microvascular dysfunction in patients with type 2 diabetes mellitus without obstructive coronary artery disease. PG - 81 LID - 10.1186/s12968-017-0397-8 [doi] LID - 81 AB - BACKGROUND: Type 2 diabetes mellitus (T2DM) is associated with coronary microvascular dysfunction in the absence of obstructive coronary artery disease (CAD). Cardiovascular magnetic resonance (CMR) T1-mapping at rest and during adenosine stress can assess coronary vascular reactivity. We hypothesised that the non-contrast T1 response to vasodilator stress will be altered in patients with T2DM without CAD compared to controls due to coronary microvascular dysfunction. METHODS: Thirty-one patients with T2DM and sixteen matched healthy controls underwent CMR (3 T) for cine, rest and adenosine stress non-contrast T1-mapping (ShMOLLI), first-pass perfusion and late gadolinium enhancement (LGE) imaging. Significant CAD (>50% coronary luminal stenosis) was excluded in all patients by coronary computed tomographic angiography. RESULTS: All subjects had normal left ventricular (LV) ejection and LV mass index, with no LGE. Myocardial perfusion reserve index (MPRI) was lower in T2DM than in controls (1.60 +/- 0.44 vs 2.01 +/- 0.42; p = 0.008). There was no difference in rest native T1 values (p = 0.59). During adenosine stress, T1 values increased significantly in both T2DM patients (from 1196 +/- 32 ms to 1244 +/- 44 ms, p < 0.001) and controls (from 1194 +/- 26 ms to 1273 +/- 44 ms, p < 0.001). T2DM patients showed blunted relative stress non-contrast T1 response (T2DM: DeltaT1 = 4.1 +/- 2.9% vs. CONTROLS: DeltaT1 = 6.6 +/- 2.6%, p = 0.007) due to a blunted maximal T1 during adenosine stress (T2DM 1244 +/- 44 ms vs. controls 1273 +/- 44 ms, p = 0.045). CONCLUSIONS: Patients with well controlled T2DM, even in the absence of arterial hypertension and significant CAD, exhibit blunted maximal non-contrast T1 response during adenosine vasodilatory stress, likely reflecting coronary microvascular dysfunction. Adenosine stress and rest T1 mapping can detect subclinical abnormalities of the coronary microvasculature, without the need for gadolinium contrast agents. CMR may identify early features of the diabetic heart phenotype and subclinical cardiac risk markers in patients with T2DM, providing an opportunity for early therapeutic intervention. FAU - Levelt, Eylem AU - Levelt E AD - University of Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK. AD - Department of Cardiovascular Sciences, University of Leicester, Leicester, UK. FAU - Piechnik, Stefan K AU - Piechnik SK AD - University of Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK. FAU - Liu, Alexander AU - Liu A AD - University of Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK. FAU - Wijesurendra, Rohan S AU - Wijesurendra RS AD - University of Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK. FAU - Mahmod, Masliza AU - Mahmod M AD - University of Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK. FAU - Ariga, Rina AU - Ariga R AD - University of Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK. FAU - Francis, Jane M AU - Francis JM AD - University of Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK. FAU - Greiser, Andreas AU - Greiser A AD - Siemens Healthcare GmbH, Erlangen, Germany. FAU - Clarke, Kieran AU - Clarke K AD - Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, UK. FAU - Neubauer, Stefan AU - Neubauer S AD - University of Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK. FAU - Ferreira, Vanessa M AU - Ferreira VM AD - University of Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK. FAU - Karamitsos, Theodoros D AU - Karamitsos TD AUID- ORCID: 0000-0002-3799-7102 AD - University of Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK. tkaramitsos@auth.gr. AD - 1st Department of Cardiology, Aristotle University of Thessaloniki, AHEPA Hospital St. Kyriakidi 1, 54636, Thessaloniki, Greece. tkaramitsos@auth.gr. LA - eng GR - FS/12/32/29559/BHF_/British Heart Foundation/United Kingdom GR - FS/15/11/31233/BHF_/British Heart Foundation/United Kingdom PT - Journal Article PT - Observational Study DEP - 20171025 PL - England TA - J Cardiovasc Magn Reson JT - Journal of cardiovascular magnetic resonance : official journal of the Society for Cardiovascular Magnetic Resonance JID - 9815616 RN - 0 (Contrast Media) RN - 0 (Organometallic Compounds) RN - 0 (Vasodilator Agents) RN - 6HG8UB2MUY (Meglumine) RN - K72T3FS567 (Adenosine) RN - L0ND3981AG (gadoterate meglumine) SB - IM EIN - J Cardiovasc Magn Reson. 2017 Dec 7;19(1):99. PMID: 29212500 MH - Adenosine/*administration & dosage MH - Adult MH - Case-Control Studies MH - Contrast Media/administration & dosage MH - Coronary Artery Disease/*diagnostic imaging/etiology/physiopathology MH - *Coronary Circulation MH - Coronary Vessels/*diagnostic imaging/physiopathology MH - Diabetes Mellitus, Type 2/*complications/diagnosis MH - Diabetic Angiopathies/*diagnostic imaging/etiology/physiopathology MH - Early Diagnosis MH - Female MH - Humans MH - *Magnetic Resonance Imaging, Cine MH - Male MH - Meglumine/administration & dosage MH - *Microcirculation MH - Middle Aged MH - Myocardial Perfusion Imaging/*methods MH - Observer Variation MH - Organometallic Compounds/administration & dosage MH - Predictive Value of Tests MH - Reproducibility of Results MH - Stroke Volume MH - Vasodilator Agents/*administration & dosage MH - Ventricular Function, Left PMC - PMC5655826 OTO - NOTNLM OT - Cardiovascular magnetic resonance OT - Diabetes mellitus OT - Microvascular obstruction OT - Myocardial perfusion OT - ShMOLLI T1-mapping COIS- ETHICS APPROVAL AND CONSENT TO PARTICIPATE: The study was approved by the National Research Ethics Committee (Ref 13/SW/0257), and informed written consent was obtained from each participant. CONSENT FOR PUBLICATION: All subjects gave written informed consent for publication. COMPETING INTERESTS: SKP has patent authorship rights for U.S. patent 9,285,446 B2. Systems and methods for shortenedLlook Locker inversion recovery (Sh-MOLLI) cardiac gated mapping of T1. Granted March 15, 2016. All rights transferred to Siemens Medical. All other authors have no relationships relevant to the contents of this paper to disclose. PUBLISHER'S NOTE: Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. EDAT- 2017/10/27 06:00 MHDA- 2018/07/17 06:00 PMCR- 2017/10/25 CRDT- 2017/10/27 06:00 PHST- 2017/02/21 00:00 [received] PHST- 2017/10/12 00:00 [accepted] PHST- 2017/10/27 06:00 [entrez] PHST- 2017/10/27 06:00 [pubmed] PHST- 2018/07/17 06:00 [medline] PHST- 2017/10/25 00:00 [pmc-release] AID - S1097-6647(23)01115-8 [pii] AID - 397 [pii] AID - 10.1186/s12968-017-0397-8 [doi] PST - epublish SO - J Cardiovasc Magn Reson. 2017 Oct 25;19(1):81. doi: 10.1186/s12968-017-0397-8.