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Still waters run deep: progression of left ventricular mass and stagnant atherosclerosis of carotid artery in patients with type 2 diabetes mellitus and coronary heart disease - insights from a long-term CMR study
© Xiong et al.; licensee BioMed Central Ltd. 2014
Published: 16 January 2014
Patients with type 2 diabetes mellitus (T2DM) and coronary artery disease (CAD) are at high cardiovascular risk. Both carotid intima-media thickness (CIMT) and left ventricular (LV) mass are predictors for cardiovascular events and are commonly increased in these patients. However, the mechanism of association is poorly understood. This study sought to determine that relationship and to evaluate the role of CIMT in risk prediction in T2DM patients with and without CAD.
Cardiovascular magnetic resonance (CMR) imaging was performed at baseline and at 2-year follow-up in 88 patients with type 2 diabetes (52 men, mean age 61 ± 8 years) including 31 patients with CAD. LV mass index (LVMI) was determined by indexing LV mass to body surface area. For carotid arteries lumen area and total vessel area were assessed and vessel wall area and vessel wall ratio (VWR = vessel wall area/body surface area) were calculated. CIMT was measured by ultrasound.
With higher values in CAD patients at baseline, LVMI showed a significant increment in T2DM patients with and without CAD. Interestingly, both vessel wall ratio and CIMT of carotid artery remained unchanged and showed no difference between the subgroups. These findings suggest that traditional CIMT assessment for risk stratification may underestimate risk in T2DM patients especially with co-existing CAD. A combined cardiac and vascular imaging approach may improve risk prediction in this patient group.
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