title: Cohort comparison study of cardiac disease and atherosclerotic burden in type 2 diabetic adults using whole body cardiovascular magnetic resonance imaging.
abstract: BACKGROUND
  Whole body cardiovascular MR (WB CVMR) combines whole body angiography and cardiac MR assessment. It is accepted that there is a high disease burden in patients with diabetes, however the quantification of the whole body atheroma burden in both arterial and cardiac disease has not been previously reported. In this study we compare the quantified atheroma burden in those individuals with and without diabetes by clinical cardiovascular disease (CVD) status.
  
  
  METHODS
  158 participants underwent WB CVMR, and were categorised into one of four groups: (1) type 2 diabetes mellitus (T2DM) with CVD; (2) T2DM without CVD; (3) CVD without T2DM; (4) healthy controls. The arterial tree was subdivided into 31 segments and each scored according to the degree of stenosis. From this a standardised atheroma score (SAS) was calculated. Cardiac MR and late gadolinium enhancement images of the left ventricle were obtained for assessment of mass, volume and myocardial scar assessment.
  
  
  RESULTS
  148 participants completed the study protocol--61% male, with mean age of 64 ± 8.2 years. SAS was highest in those with cardiovascular disease without diabetes [10.1 (0-39.5)], followed by those with T2DM and CVD [4 (0-41.1)], then those with T2DM only [3.23 (0-19.4)] with healthy controls having the lowest atheroma score [2.4 (0-19.4)]. Both groups with a prior history of CVD had a higher SAS and left ventricular mass than those without (p < 0.001 for both). However after accounting for known cardiovascular risk factors, only the SAS in the group with CVD without T2DM remained significantly elevated. 6% of the T2DM group had evidence of silent myocardial infarct, with this subcohort having a higher SAS than the remainder of the T2DM group [7.7 (4-19) vs. 2.8 (0-17), p = 0.024].
  
  
  CONCLUSIONS
  Global atheroma burden was significantly higher in those with known cardiovascular disease and without diabetes but not in those with diabetes and cardiovascular disease suggesting that cardiovascular events may occur at a lower atheroma burden in diabetes.
authors.affiliation: Division of Cardiovascular and Diabetes Medicine, Medical Research Institute, University of Dundee, Level 7, Ninewells Hospital, Dundee, DD1 9SY, UK. s.duce@dundee.ac.uk.
authors.forename: Suzanne L
authors.initials: SL
authors.lastname: Duce
authors.affiliation: Division of Cardiovascular and Diabetes Medicine, Medical Research Institute, University of Dundee, Level 7, Ninewells Hospital, Dundee, DD1 9SY, UK. jweirmccall@gmail.com.|NHS Tayside Clinical Radiology, Ninewells Hospital, Dundee, DD1 9SY, UK. jweirmccall@gmail.com.
authors.forename: Jonathan R
authors.initials: JR
authors.lastname: Weir-McCall
authors.affiliation: NHS Tayside Clinical Radiology, Ninewells Hospital, Dundee, DD1 9SY, UK. stephen.gandy@nhs.net.|NHS Tayside Medical Physics, Ninewells Hospital, Dundee, DD1 9SY, UK. stephen.gandy@nhs.net.
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Gandy
authors.affiliation: Division of Cardiovascular and Diabetes Medicine, Medical Research Institute, University of Dundee, Level 7, Ninewells Hospital, Dundee, DD1 9SY, UK. s.z.matthew@dundee.ac.uk.
authors.forename: Shona Z
authors.initials: SZ
authors.lastname: Matthew
authors.affiliation: Division of Cardiovascular and Diabetes Medicine, Medical Research Institute, University of Dundee, Level 7, Ninewells Hospital, Dundee, DD1 9SY, UK. d.b.cassidy@dundee.ac.uk.
authors.forename: Deirdre B
authors.initials: DB
authors.lastname: Cassidy
authors.affiliation: Division of Cardiovascular and Diabetes Medicine, Medical Research Institute, University of Dundee, Level 7, Ninewells Hospital, Dundee, DD1 9SY, UK. l.mccormick@dundee.ac.uk.
authors.forename: Lynne
authors.initials: L
authors.lastname: McCormick
authors.affiliation: Dundee Epidemiological and Biostatistics Unit, University of Dundee, Dundee, DD1 9SY, UK. p.rauchhaus@dundee.ac.uk.
authors.forename: Petra
authors.initials: P
authors.lastname: Rauchhaus
authors.affiliation: Division of Population Health Sciences, Medical Research Institute, University of Dundee, The Mackenzie Building, Dundee, DD2 4BF, UK. h.c.looker@dundee.ac.uk.
authors.forename: Helen
authors.initials: H
authors.lastname: Looker
authors.affiliation: Division of Population Health Sciences, Medical Research Institute, University of Dundee, The Mackenzie Building, Dundee, DD2 4BF, UK. h.colhoun@dundee.ac.uk.
authors.forename: Helen M
authors.initials: HM
authors.lastname: Colhoun
authors.affiliation: Division of Cardiovascular and Diabetes Medicine, Medical Research Institute, University of Dundee, Level 7, Ninewells Hospital, Dundee, DD1 9SY, UK. ghouston@nhs.net.|NHS Tayside Clinical Radiology, Ninewells Hospital, Dundee, DD1 9SY, UK. ghouston@nhs.net.
authors.forename: J Graeme
authors.initials: JG
authors.lastname: Houston
mesh_terms: D000368:Aged; D050197:Atherosclerosis / Q000175:diagnosis* / Q000209:etiology; D016022:Case-Control Studies; D003287:Contrast Media; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000175:diagnosis; D003925:Diabetic Angiopathies / Q000175:diagnosis* / Q000209:etiology; D005260:Female; D006331:Heart Diseases / Q000175:diagnosis* / Q000209:etiology; D006801:Humans; D018810:Magnetic Resonance Angiography; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D051598:Whole Body Imaging / Q000379:methods*
chemical_list: D003287:Contrast Media