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Cine Displacement ENcoding imaging with Stimulated Echoes (cine-DENSE) confirms systolic myocardial dysfunction in asymptomatic patients with type 2 diabetes mellitus: comparison with MR-tagging


Diabetic cardiomyopathy contributes to increased cardiovascular mortality in diabetes mellitus (DM) patients and is characterized by a progressive alteration of left ventricular (LV) function. At a preclinical stage, a decrease in systolic myocardial strain has been suggested in echocardiographic studies.

MRI techniques remain the gold standard for quantification of myocardial deformation but only a single study suggested systolic abnormalities in type 2 DM patients with evidence of diastolic dysfunction.

MR-tagging is the most common technique for strain calculation using CMR but is intrinsically limited in measuring transmural variations. Cine-Displacement ENcoding Imaging with Stimulated Echoes(DENSE) has been recently proposed as an alternative that benefits from an increased spatial resolution.


To evaluate whether cine-DENSE and MR-tagging confirm the existence of a sub-clinical myocardial dysfunction in a population of type 2 DM patients with no sign or history of heart disease and normal conventional echo and MRI parameters.


37 patients with type 2 DM (50.6±5.6 years, 8 females, HbA1c 7.6±1.2%) and 21 age-matched controls (49.7±8.0 years, 11 females) underwent a CMR study on a 1.5T scanner. Subjects were excluded if standard echocardiography showed significant abnormality. After a standard CMR study for conventional LV function assessment, two-dimensional cine-DENSE pulse sequence with short-echo train echo-planar imaging readout and cine-tagging with complementary spatial modulation of magnetization(CSPAMM) were acquired in short axis views at the same basal, mid and apical levels. LV volumes and ejection fraction were measured on cine-MRI images. Regional circumferential maximal systolic strain(εc) was calculated from cine-DENSE and MR-tagging acquisitions on 16 LV segments. Average maximal systolic strain in each slice and a whole heart mean value(εcmean) for each patient were calculated. Post-processing of cine-DENSE acquisitions included adaptive phase-unwrapping and spatial filtering. CSPAMM images were processed using InTag post-processing toolbox (Creatis, Lyon, France) implemented in OsiriX software (Geneva, Switzerland) with motion estimation based on the Sine Wave Modeling approach.


Standard cine-MRI LV function parameters were normal and comparable between groups (table 1). Whereas LV ejection fraction was similar in the 2 groups, cine-DENSE showed a significant decrease in εc at basal, mid and apical LV level and in εcmean in the DM group as compared to controls. MR-tagging confirmed a decrease in εc at the 3 LV levels and in εcmean in DM patients as compared with controls.

Table 1 Left ventricular function in type 2 diabetes mellitus patients and controls.


Cine-DENSE and MR-tagging confirm subclinical myocardial dysfunction in asymptomatic patients with Type II DM.

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Correspondence to Laura Ernande.

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Ernande, L., Wen, H., Bergerot, C. et al. Cine Displacement ENcoding imaging with Stimulated Echoes (cine-DENSE) confirms systolic myocardial dysfunction in asymptomatic patients with type 2 diabetes mellitus: comparison with MR-tagging. J Cardiovasc Magn Reson 13, P280 (2011).

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  • Diabetes Mellitus Patient
  • ENcoding Image
  • Diabetes Mellitus Group
  • Left Ventricular Segment
  • Left Ventricular Function Parameter