Occult coronary microvascular dysfunction and ischaemic heart disease in patients with diabetes and heart failure

Noor Sharrack; Louise A. E. Brown; Jonathan Farley; Ali Wahab; Nicholas Jex; Sharmaine Thirunavukarasu; Amrit Chowdhary; Miroslawa Gorecka; Wasim Javed; Hui Xue; Eylem Levelt; Erica Dall’Armellina; Peter Kellman; Pankaj Garg; John P. Greenwood; Sven Plein; Peter P. Swoboda

doi:10.1016/j.jocmr.2024.101073

Occult coronary microvascular dysfunction and ischaemic heart disease in patients with diabetes and heart failure

Noor Sharrack, Louise A. E. Brown, Jonathan Farley, Ali Wahab, Nicholas Jex, Sharmaine Thirunavukarasu, Amrit Chowdhary, Miroslawa Gorecka, Wasim Javed, Hui Xue, Eylem Levelt, Erica Dall’Armellina, Peter Kellman, Pankaj Garg, John P. Greenwood, Sven Plein, Peter P. Swoboda

Research output: Contribution to journal › Article › peer-review

Abstract

Background: Patients with diabetes (DM) and heart failure (HF) have worse outcomes than normoglycaemic HF patients. Cardiovascular magnetic resonance (CMR) can identify ischaemic heart disease (IHD) and quantify coronary microvascular dysfunction (CMD) using myocardial perfusion reserve (MPR). We aimed to quantify extent of silent IHD and CMD in patients with DM presenting with HF.

Methods: Prospectively recruited outpatients undergoing assessment into the aetiology of HF underwent inline quantitative perfusion CMR for calculation of stress and rest myocardial blood flow (MBF) and MPR. Exclusions included angina or history of IHD. Patients were followed up (median 3.0 years) for major adverse cardiovascular events (MACE).

Results: Final analysis included 343 patients (176 normoglycaemic, 84 with pre-diabetes and 83 with DM). Prevalence of silent IHD was highest in DM (31%), then pre-diabetes (20%) then normoglycaemia (17%). Stress MBF was lowest in DM (1.53±0.52), then pre-diabetes (1.59±0.54) then normoglycaemia (1.83±0.62). MPR was lowest in DM (2.37±0.85) then pre-diabetes (2.41±0.88) then normoglycaemia (2.61±0.90). During follow up 45 patients experienced at least one MACE. On univariate Cox regression analysis MPR and presence of silent IHD were both associated with MACE. However, after correction for HbA1c, age and left ventricular ejection fraction the associations were no longer significant.

Conclusions: Patients with DM and HF had higher prevalence of silent IHD, more evidence of CMD and worse cardiovascular outcomes than their non-diabetic counterparts. These findings highlight the potential value of CMR for assessment of silent IHD and CMD in patients with DM presenting with HF.

Original language	English
Article number	101073
Journal	Journal of Cardiovascular Magnetic Resonance
Volume	26
Issue number	2
Early online date	2 Aug 2024
DOIs	https://doi.org/10.1016/j.jocmr.2024.101073
Publication status	Published - Sep 2024

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Sharrack, N., Brown, L. A. E., Farley, J., Wahab, A., Jex, N., Thirunavukarasu, S., Chowdhary, A., Gorecka, M., Javed, W., Xue, H., Levelt, E., Dall’Armellina, E., Kellman, P., Garg, P., Greenwood, J. P., Plein, S., & Swoboda, P. P. (2024). Occult coronary microvascular dysfunction and ischaemic heart disease in patients with diabetes and heart failure. Journal of Cardiovascular Magnetic Resonance, 26(2), [101073]. https://doi.org/10.1016/j.jocmr.2024.101073

Sharrack, Noor ; Brown, Louise A. E. ; Farley, Jonathan ; Wahab, Ali ; Jex, Nicholas ; Thirunavukarasu, Sharmaine ; Chowdhary, Amrit ; Gorecka, Miroslawa ; Javed, Wasim ; Xue, Hui ; Levelt, Eylem ; Dall’Armellina, Erica ; Kellman, Peter ; Garg, Pankaj ; Greenwood, John P. ; Plein, Sven ; Swoboda, Peter P. / Occult coronary microvascular dysfunction and ischaemic heart disease in patients with diabetes and heart failure. In: Journal of Cardiovascular Magnetic Resonance. 2024 ; Vol. 26, No. 2.

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title = "Occult coronary microvascular dysfunction and ischaemic heart disease in patients with diabetes and heart failure",

abstract = "Background: Patients with diabetes (DM) and heart failure (HF) have worse outcomes than normoglycaemic HF patients. Cardiovascular magnetic resonance (CMR) can identify ischaemic heart disease (IHD) and quantify coronary microvascular dysfunction (CMD) using myocardial perfusion reserve (MPR). We aimed to quantify extent of silent IHD and CMD in patients with DM presenting with HF. Methods: Prospectively recruited outpatients undergoing assessment into the aetiology of HF underwent inline quantitative perfusion CMR for calculation of stress and rest myocardial blood flow (MBF) and MPR. Exclusions included angina or history of IHD. Patients were followed up (median 3.0 years) for major adverse cardiovascular events (MACE). Results: Final analysis included 343 patients (176 normoglycaemic, 84 with pre-diabetes and 83 with DM). Prevalence of silent IHD was highest in DM (31%), then pre-diabetes (20%) then normoglycaemia (17%). Stress MBF was lowest in DM (1.53±0.52), then pre-diabetes (1.59±0.54) then normoglycaemia (1.83±0.62). MPR was lowest in DM (2.37±0.85) then pre-diabetes (2.41±0.88) then normoglycaemia (2.61±0.90). During follow up 45 patients experienced at least one MACE. On univariate Cox regression analysis MPR and presence of silent IHD were both associated with MACE. However, after correction for HbA1c, age and left ventricular ejection fraction the associations were no longer significant. Conclusions: Patients with DM and HF had higher prevalence of silent IHD, more evidence of CMD and worse cardiovascular outcomes than their non-diabetic counterparts. These findings highlight the potential value of CMR for assessment of silent IHD and CMD in patients with DM presenting with HF.",

author = "Noor Sharrack and Brown, {Louise A. E.} and Jonathan Farley and Ali Wahab and Nicholas Jex and Sharmaine Thirunavukarasu and Amrit Chowdhary and Miroslawa Gorecka and Wasim Javed and Hui Xue and Eylem Levelt and Erica Dall{\textquoteright}Armellina and Peter Kellman and Pankaj Garg and Greenwood, {John P.} and Sven Plein and Swoboda, {Peter P.}",

note = "Availability of data and materials: The datasets used and analyzed during the current study are available from the corresponding author on reasonable request. Funding information: This research was funded by British Heart Foundation (RG/16/1/32092). S.P. is supported by a British Heart Foundation Chair (CH/16/2/32089). E.L. acknowledges support from the Wellcome Trust (221690/Z/20/Z). This research is supported by the National Institute for Health Research (NIHR) through the Local Clinical Research Networks and the Leeds Clinical Research Facility. ",

year = "2024",

month = sep,

doi = "10.1016/j.jocmr.2024.101073",

language = "English",

volume = "26",

journal = "Journal of Cardiovascular Magnetic Resonance",

issn = "1097-6647",

publisher = "BioMed Central",

number = "2",

}

Sharrack, N, Brown, LAE, Farley, J, Wahab, A, Jex, N, Thirunavukarasu, S, Chowdhary, A, Gorecka, M, Javed, W, Xue, H, Levelt, E, Dall’Armellina, E, Kellman, P, Garg, P, Greenwood, JP, Plein, S & Swoboda, PP 2024, 'Occult coronary microvascular dysfunction and ischaemic heart disease in patients with diabetes and heart failure', Journal of Cardiovascular Magnetic Resonance, vol. 26, no. 2, 101073. https://doi.org/10.1016/j.jocmr.2024.101073

Occult coronary microvascular dysfunction and ischaemic heart disease in patients with diabetes and heart failure. / Sharrack, Noor; Brown, Louise A. E.; Farley, Jonathan; Wahab, Ali; Jex, Nicholas; Thirunavukarasu, Sharmaine; Chowdhary, Amrit; Gorecka, Miroslawa; Javed, Wasim; Xue, Hui; Levelt, Eylem; Dall’Armellina, Erica; Kellman, Peter; Garg, Pankaj; Greenwood, John P.; Plein, Sven; Swoboda, Peter P.

In: Journal of Cardiovascular Magnetic Resonance, Vol. 26, No. 2, 101073, 09.2024.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Occult coronary microvascular dysfunction and ischaemic heart disease in patients with diabetes and heart failure

AU - Sharrack, Noor

AU - Brown, Louise A. E.

AU - Farley, Jonathan

AU - Wahab, Ali

AU - Jex, Nicholas

AU - Thirunavukarasu, Sharmaine

AU - Chowdhary, Amrit

AU - Gorecka, Miroslawa

AU - Javed, Wasim

AU - Xue, Hui

AU - Levelt, Eylem

AU - Dall’Armellina, Erica

AU - Kellman, Peter

AU - Garg, Pankaj

AU - Greenwood, John P.

AU - Plein, Sven

AU - Swoboda, Peter P.

N1 - Availability of data and materials: The datasets used and analyzed during the current study are available from the corresponding author on reasonable request. Funding information: This research was funded by British Heart Foundation (RG/16/1/32092). S.P. is supported by a British Heart Foundation Chair (CH/16/2/32089). E.L. acknowledges support from the Wellcome Trust (221690/Z/20/Z). This research is supported by the National Institute for Health Research (NIHR) through the Local Clinical Research Networks and the Leeds Clinical Research Facility.

PY - 2024/9

Y1 - 2024/9

N2 - Background: Patients with diabetes (DM) and heart failure (HF) have worse outcomes than normoglycaemic HF patients. Cardiovascular magnetic resonance (CMR) can identify ischaemic heart disease (IHD) and quantify coronary microvascular dysfunction (CMD) using myocardial perfusion reserve (MPR). We aimed to quantify extent of silent IHD and CMD in patients with DM presenting with HF. Methods: Prospectively recruited outpatients undergoing assessment into the aetiology of HF underwent inline quantitative perfusion CMR for calculation of stress and rest myocardial blood flow (MBF) and MPR. Exclusions included angina or history of IHD. Patients were followed up (median 3.0 years) for major adverse cardiovascular events (MACE). Results: Final analysis included 343 patients (176 normoglycaemic, 84 with pre-diabetes and 83 with DM). Prevalence of silent IHD was highest in DM (31%), then pre-diabetes (20%) then normoglycaemia (17%). Stress MBF was lowest in DM (1.53±0.52), then pre-diabetes (1.59±0.54) then normoglycaemia (1.83±0.62). MPR was lowest in DM (2.37±0.85) then pre-diabetes (2.41±0.88) then normoglycaemia (2.61±0.90). During follow up 45 patients experienced at least one MACE. On univariate Cox regression analysis MPR and presence of silent IHD were both associated with MACE. However, after correction for HbA1c, age and left ventricular ejection fraction the associations were no longer significant. Conclusions: Patients with DM and HF had higher prevalence of silent IHD, more evidence of CMD and worse cardiovascular outcomes than their non-diabetic counterparts. These findings highlight the potential value of CMR for assessment of silent IHD and CMD in patients with DM presenting with HF.

AB - Background: Patients with diabetes (DM) and heart failure (HF) have worse outcomes than normoglycaemic HF patients. Cardiovascular magnetic resonance (CMR) can identify ischaemic heart disease (IHD) and quantify coronary microvascular dysfunction (CMD) using myocardial perfusion reserve (MPR). We aimed to quantify extent of silent IHD and CMD in patients with DM presenting with HF. Methods: Prospectively recruited outpatients undergoing assessment into the aetiology of HF underwent inline quantitative perfusion CMR for calculation of stress and rest myocardial blood flow (MBF) and MPR. Exclusions included angina or history of IHD. Patients were followed up (median 3.0 years) for major adverse cardiovascular events (MACE). Results: Final analysis included 343 patients (176 normoglycaemic, 84 with pre-diabetes and 83 with DM). Prevalence of silent IHD was highest in DM (31%), then pre-diabetes (20%) then normoglycaemia (17%). Stress MBF was lowest in DM (1.53±0.52), then pre-diabetes (1.59±0.54) then normoglycaemia (1.83±0.62). MPR was lowest in DM (2.37±0.85) then pre-diabetes (2.41±0.88) then normoglycaemia (2.61±0.90). During follow up 45 patients experienced at least one MACE. On univariate Cox regression analysis MPR and presence of silent IHD were both associated with MACE. However, after correction for HbA1c, age and left ventricular ejection fraction the associations were no longer significant. Conclusions: Patients with DM and HF had higher prevalence of silent IHD, more evidence of CMD and worse cardiovascular outcomes than their non-diabetic counterparts. These findings highlight the potential value of CMR for assessment of silent IHD and CMD in patients with DM presenting with HF.

U2 - 10.1016/j.jocmr.2024.101073

DO - 10.1016/j.jocmr.2024.101073

M3 - Article

VL - 26

JO - Journal of Cardiovascular Magnetic Resonance

JF - Journal of Cardiovascular Magnetic Resonance

SN - 1097-6647

IS - 2

M1 - 101073

ER -