Skip to main content

Advertisement

Springer Nature is making SARS-CoV-2 and COVID-19 research free. View research | View latest news | Sign up for updates

Aortic stiffness as an independent predictor of cardiac function and cerebral white matter hyperintensities in diabetes mellitus assessed by Magnetic Resonance Imaging

  • 731 Accesses

Introduction

Diabetes Mellitus (DM) causes damage in multiple organs and the vessels due to the metabolic state of hyperglycemia and insulin resistance. Increased arterial stiffness may be an important pathway linking DM to the increased cardiovascular (CV) risk by mechanisms of increased cardiac afterload, augmentation of pulse pressure, a subsequent transmission of high pulsatile flow to the end organs and furthermore as a representative of arteriosclerosis. Magnetic Resonance (MR) assessment of aortic pulse wave velocity (PWV) offers a good reproducible non-invasive tool for the detection of arterial stiffness. Furthermore MRI is an accurate tool for the detection of cardiac dysfunction and vascular cerebral lesions, like white matter hyperintensities (WMHs). To our knowledge, MRI has not previously been used to simultaneously determine end organ damage in the aorta, heart and the brain in patients with DM. We hypothesize that there is an important role for DM induced aortic stiffness in the underlying mechanism of cardiac failure and cerebral white matter hyperintensities in DM patients.

Purpose

Accordingly, the purpose of this study is to examine the possible association between aortic PWV, cardiac left ventricular (LV) function and cerebral white matter hyperintensities in DM patients using MRI.

Methods

MRI of the aorta, the heart and the brain was performed in 81 consecutively included subjects with proven DM (50 men; mean age 48 ± 12 years). PWV (defined as the propagation speed of the systolic wave front) was assessed using velocity-encoded MRI at two predefined levels in the aorta: in the aortic arch and the descending aorta. Short-axis MRI using a steady-state free precession sequence was performed to assess LV ejection fraction and LV mass. Transmitral flow measurements were performed by means of velocity-encoded MRI for the evaluation of LV diastolic function. WMHs on spin-echo T2-weighted and FLAIR sequences were separately evaluated according to their two anatomical subtypes – periventricular (pv) and subcortical (sc) – and respectively quantified using the Fazekas classification. Spearman correlation, independent student t-test, multivariate linear and logistic regression models were applied for statistical analysis.

Results

PWV in the aortic arch was significantly associated with LV diastolic function (r = -0.619, p = 0.000), LV ejection fraction (r = -0.227, p = 0.042) and periventricular WMHs (p = 0.006). PWV in the descending aorta was significantly associated with LV diastolic function (r = -0.567, p = 0.000) and subcortical WMHs (p = 0.002). Furthermore, in multivariate regression analysis with confounding age, gender, smoking and duration of DM, PWV in the aortic arch was an independent predictor of LV diastolic function (R = 0.803, p = 0.002), LV ejection fraction (R = 0.471, p = 0.001), LV mass indexed for body surface area (R = 0.707, p = 0.004) and pv WMHs (OR = 1.329, p = 0.023).

Conclusion

Stiffening of the aorta is associated with cardiac LV dysfunction and lesions of the cerebral white matter in DM. Moreover, PWV of the aortic arch is an independent predictor of cardiac LV diastolic and systolic function, LV mass and cerebral periventricular white matter hyperintensities in DM patients.

Author information

Correspondence to Saskia GC van Elderen.

Rights and permissions

Open Access This article is published under license to BioMed Central Ltd. This is an Open Access article is distributed under the terms of the Creative Commons Attribution 2.0 International License (https://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Reprints and Permissions

About this article

Cite this article

van Elderen, S.G., Brandts, A., Westenberg, J. et al. Aortic stiffness as an independent predictor of cardiac function and cerebral white matter hyperintensities in diabetes mellitus assessed by Magnetic Resonance Imaging. J Cardiovasc Magn Reson 11, P169 (2009). https://doi.org/10.1186/1532-429X-11-S1-P169

Download citation

Keywords

  • Left Ventricular Ejection Fraction
  • Aortic Arch
  • Arterial Stiffness
  • Pulse Wave Velocity
  • Left Ventricular Mass