title: Association between diffuse myocardial fibrosis by cardiac magnetic resonance contrast-enhanced T₁ mapping and subclinical myocardial dysfunction in diabetic patients: a pilot study.
abstract: BACKGROUND
  Diabetic patients have increased interstitial myocardial fibrosis on histological examination. Magnetic resonance imaging (MRI) T(1) mapping is a previously validated imaging technique that can quantify the burden of global and regional interstitial fibrosis. However, the association between MRI T(1) mapping and subtle left ventricular (LV) dysfunction in diabetic patients is unknown.
  
  
  RESULTS
  Fifty diabetic patients with normal LV ejection fraction (EF) and no underlying coronary artery disease or regional macroscopic scar on MRI delayed enhancement were prospectively recruited. Diabetic patients were compared with 19 healthy controls who were frequency matched in age, sex and body mass index. There were no significant differences in mean LV end-diastolic volume index, end-systolic volume index and LVEF between diabetic patients and healthy controls. Diabetic patients had significantly shorter global contrast-enhanced myocardial T(1) time (425±72 ms vs. 504±34 ms, P<0.001). There was no correlation between global contrast-enhanced myocardial T(1) time and LVEF (r=0.14, P=0.32) in the diabetic patients. However, there was good correlation between global contrast-enhanced myocardial T(1) time and global longitudinal strain (r=-0.73, P<0.001). Global contrast-enhanced myocardial T(1) time was the strongest independent determinant of global longitudinal strain on multivariate analysis (standardized β=-0.626, P<0.001). Similarly, there was good correlation between global contrast-enhanced myocardial T(1) time and septal E' (r=0.54, P<0.001). Global contrast-enhanced myocardial T(1) time was also the strongest independent determinant of septal E' (standardized β=0.432, P<0.001).
  
  
  CONCLUSIONS
  A shorter global contrast-enhanced myocardial T(1) time was associated with more impaired longitudinal myocardial systolic and diastolic function in diabetic patients.
authors.affiliation: Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands. arnoldct@hotmail.com
authors.forename: Arnold C T
authors.initials: AC
authors.lastname: Ng
authors.forename: Dominique
authors.initials: D
authors.lastname: Auger
authors.forename: Victoria
authors.initials: V
authors.lastname: Delgado
authors.forename: Saskia G C
authors.initials: SG
authors.lastname: van Elderen
authors.forename: Matteo
authors.initials: M
authors.lastname: Bertini
authors.forename: Hans-Marc
authors.initials: HM
authors.lastname: Siebelink
authors.forename: Rob J
authors.initials: RJ
authors.lastname: van der Geest
authors.forename: Cosimo
authors.initials: C
authors.lastname: Bonetti
authors.forename: Enno T
authors.initials: ET
authors.lastname: van der Velde
authors.forename: Albert
authors.initials: A
authors.lastname: de Roos
authors.forename: Johannes W A
authors.initials: JW
authors.lastname: Smit
authors.forename: Dominic Y
authors.initials: DY
authors.lastname: Leung
authors.forename: Jeroen J
authors.initials: JJ
authors.lastname: Bax
authors.forename: Hildo J
authors.initials: HJ
authors.lastname: Lamb
mesh_terms: D009202:Cardiomyopathies / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology*; D003287:Contrast Media; D003920:Diabetes Mellitus; D004452:Echocardiography; D005260:Female; D005355:Fibrosis; D019786:Gadolinium DTPA; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D010865:Pilot Projects; D011446:Prospective Studies; D018487:Ventricular Dysfunction, Left / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology*
chemical_list: D003287:Contrast Media; D019786:Gadolinium DTPA