title: Association of imaging markers of myocardial fibrosis with metabolic and functional disturbances in early diabetic cardiomyopathy.
abstract: BACKGROUND
  Metabolic and vascular disturbances contribute to diabetic cardiomyopathy, but the role of interstitial fibrosis in early disease is unproven. We sought to assess the relationship between imaging markers of diffuse fibrosis and myocardial dysfunction and to link this to possible causes of early diabetic cardiomyopathy.
  
  
  RESULTS
  Hemodynamic and metabolic data were measured in 67 subjects with type 2 diabetes mellitus (age 60±10 years) with no cardiac symptoms. Myocardial function was evaluated with standard echocardiography and myocardial deformation; ischemia was excluded by exercise echocardiography. Calibrated integrated backscatter was calculated from parasternal long-axis views. T1 mapping was performed after contrast with a modified Look-Locker technique using saturation recovery images. Amino-terminal propeptides of procollagens type I and III, as well as the carboxy-terminal propeptide of procollagen type I, were assayed to determine collagen turnover. Subjects with abnormal early diastolic tissue velocity (E(m)) had shorter postcontrast T1 values (P=0.042) and higher calibrated integrated backscatter (P=0.007). They were heavier (P=0.003) and had worse exercise capacity (P<0.001), lower insulin sensitivity (P=0.003), and blunted systolic tissue velocity (P=0.05). Postcontrast T1 was associated with diastolic dysfunction (E(m) r=0.28, P=0.020; E/E(m) r=-0.24, P=0.049), impaired exercise capacity (r=0.30, P=0.016), central adiposity (r=-0.26, P=0.046), blood pressure (systolic r=-0.30, P=0.012; diastolic r=-0.49, P<0.001), and insulin sensitivity (r=0.30, P=0.037). The association of T1 with E/E(m) (β=-0.31, P=0.017) was independent of blood pressure and metabolic disturbance. Amino-terminal propeptide of procollagens type III was linked to diastolic dysfunction (E(m) r=-0.32, P=0.008) and calibrated integrated backscatter (r=0.30, P=0.015) but not T1 values.
  
  
  CONCLUSIONS
  The association between myocardial diastolic dysfunction, postcontrast T1 values, and metabolic disturbance supports that diffuse myocardial fibrosis is an underlying contributor to early diabetic cardiomyopathy.
authors.affiliation: University of Queensland, Brisbane, QLD, Australia.
authors.forename: Christine
authors.initials: C
authors.lastname: Jellis
authors.forename: Jeremy
authors.initials: J
authors.lastname: Wright
authors.forename: Dominic
authors.initials: D
authors.lastname: Kennedy
authors.forename: Julian
authors.initials: J
authors.lastname: Sacre
authors.forename: Carly
authors.initials: C
authors.lastname: Jenkins
authors.forename: Brian
authors.initials: B
authors.lastname: Haluska
authors.forename: Jennifer
authors.initials: J
authors.lastname: Martin
authors.forename: John
authors.initials: J
authors.lastname: Fenwick
authors.forename: Thomas H
authors.initials: TH
authors.lastname: Marwick
mesh_terms: D000368:Aged; D000886:Anthropometry; D015415:Biomarkers / Q000032:analysis*; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D058065:Diabetic Cardiomyopathies / Q000150:complications / Q000175:diagnosis* / Q000378:metabolism; D018450:Disease Progression; D042241:Early Diagnosis; D025401:Echocardiography, Stress / Q000379:methods; D004719:Endomyocardial Fibrosis / Q000150:complications / Q000175:diagnosis*; D004797:Enzyme-Linked Immunosorbent Assay; D005080:Exercise Test; D005260:Female; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index
chemical_list: D015415:Biomarkers