This article is more than 5 years old. Information may no longer be current.
Delayed-enhancement MRI better identifies heart attack risk in diabetes
Click Here to Manage Email Alerts
Nearly 20% of adults with diabetes and no symptoms for cardiac disease may be at risk for unrecognized myocardial infarction, and the use of delayed-enhancement MRI may improve the identification of those at highest risk compared with traditional imaging, according to findings published in Diabetes Care.
“We’ve known for decades that diabetics are at high risk for cardiovascular events, but the struggle has been how to identify the vulnerable diabetics. There have been a lot of things that have failed, whether its aggressive medical treatment or other cardiac imaging studies that have not shown risk reduction,” Michael D. Elliott, MD, director of cardiovascular MRI for Sanger Heart and Vascular Institute in Charlotte, North Carolina, told Endocrine Today. “Now this test, ... is providing some suggestive evidence that this may be a new way to explore cardiovascular risk stratification in diabetes.”
Elliott and colleagues conducted a prospective, two-center study with 120 participants with diabetes and no cardiac disease symptoms (mean age, 52 years; 46% women). Of the total cohort, 50 participants had type 1 diabetes and chronic kidney disease and were recruited consecutively from Northwestern Memorial Hospital (mean age, 40 years; 42% women). These participants were considered “high risk,” whereas the remaining 70, who were from Duke University Medical Center, had type 2 diabetes and were considered “average risk” (mean age, 60 years; 49% women). Recruitment for both groups occurred from 2001 to 2005. Standard 12-lead ECG and delayed-enhancement MRI were performed.
Delayed-enhancement MRI identified unrecognized MI in 19% of the total cohort compared with 5% identified by ECG (P < .001). Delayed-enhancement MRI was three times as effective at identifying unrecognized MI as 12-lead ECG, the researchers wrote.
More participants at high risk had unrecognized MI compared with the average-risk group (28% vs. 13%; P = .038), according to the researchers. Compared with those without MI, those with unrecognized MI had lower event-free survival (P < .0001). Participants with unrecognized MI also had a higher event rate (16% per year) and cardiac event rate (12.8% per year) vs. those without the condition (1.8% per year and 0.3% per year, respectively). Participants with unrecognized MI as confirmed by delayed-enhancement MRI were also at higher risk for death and MI compared with those without the condition (HR = 8; 95% CI, 3-21.1).
“Because there was such a marked outcome in death and clinical myocardial infarction for those who have this small infarction in delayed-enhancement MRI, it suggests that this may be a novel way of identifying vulnerable diabetics,” Elliott said. “There’s a spectrum of risk within patients with diabetes so it’s hopefully a better way at targeting diabetics who might benefit from more aggressive medical therapy.” – by Phil Neuffer
Disclosures: Elliott reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
Click Here to Manage Email Alerts