title: Myocardial structure, function, and scar in patients with type 1 diabetes mellitus.
abstract: BACKGROUND
  We report relationships between cardiovascular disease risk factors and myocardial structure, function, and scar in patients with type 1 diabetes mellitus in the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) study.
  
  
  RESULTS
  Cardiac magnetic resonance was obtained in 1017 patients with type 1 diabetes mellitus. Gadolinium cardiac magnetic resonance was also obtained in 741 patients. The mean age was 49±7 years; 52% were men; and mean duration of diabetes mellitus was 28±5 years. Associations of cardiovascular disease risk factors with cardiac magnetic resonance parameters were examined with linear and logistic regression models. History of macroalbuminuria was positively associated with left ventricular mass (by 14.8 g), leading to a significantly higher ratio of left ventricular mass to end-diastolic volume (by 8%). Mean hemoglobin A(1c) levels over the preceding 22 years were inversely associated with end-diastolic volume (-3.0 mL per unit mean hemoglobin A(1c) percent) and stroke volume (-2.3 mL per unit mean hemoglobin A(1c) percent) and positively related to the ratio of elevated left ventricular mass to end-diastolic volume (0.02 g/mL per unit). The overall prevalence of myocardial scar was 4.3% by cardiac magnetic resonance and 1.4% by clinical adjudication of myocardial infarction. Both mean hemoglobin A(1c) (odds ratio, 1.5 [95% confidence interval, 1.0-2.2] per unit) and macroalbuminuria (odds ratio, 3.5 [95% confidence interval, 1.2-9.9]) were significantly associated with myocardial scar and traditional cardiovascular disease risk factors.
  
  
  CONCLUSIONS
  In addition to traditional cardiovascular disease risk factors, elevated mean hemoglobin A(1c) and macroalbuminuria were significantly associated with alterations in left ventricular structure and function. The prevalence of myocardial scar was 4.3% in this subcohort of DCCT/EDIC participants with relatively preserved renal function. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifiers: NCT00360893 and NCT00360815.
authors.affiliation: National Institutes of Health Clinical Center, National Institute of Biomedical Imaging and Bioengineering, Bethesda, MD 20892, USA.
authors.forename: Evrim B
authors.initials: EB
authors.lastname: Turkbey
authors.forename: Jye-Yu C
authors.initials: JY
authors.lastname: Backlund
authors.forename: Saul
authors.initials: S
authors.lastname: Genuth
authors.forename: Aditya
authors.initials: A
authors.lastname: Jain
authors.forename: Cuilian
authors.initials: C
authors.lastname: Miao
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Cleary
authors.forename: John M
authors.initials: JM
authors.lastname: Lachin
authors.forename: David M
authors.initials: DM
authors.lastname: Nathan
authors.forename: Rob J
authors.initials: RJ
authors.lastname: van der Geest
authors.forename: Elsayed Z
authors.initials: EZ
authors.lastname: Soliman
authors.forename: Chia-Ying
authors.initials: CY
authors.lastname: Liu
authors.forename: João A C
authors.initials: JA
authors.lastname: Lima
authors.forename: David A
authors.initials: DA
authors.lastname: Bluemke
mesh_terms: D000328:Adult; D000419:Albuminuria; D002318:Cardiovascular Diseases / Q000209:etiology*; D002921:Cicatrix; D048909:Diabetes Complications / Q000175:diagnosis; D003922:Diabetes Mellitus, Type 1 / Q000175:diagnosis / Q000473:pathology*; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000473:pathology; D012307:Risk Factors
chemical_list: D006442:Glycated Hemoglobin