Abstract 15503: Strong Association Between Carotid Intima Media Thickness and Myocardial Scar Detected by CMR in Asymptomatic Type 2 Diabetic Patients
Background: Carotid intima media thickness (IMT) is an established surrogate marker for coronary artery disease (CAD). Cardiac magnetic resonance (CMR) is recognized as the most sensitive method to detect small myocardial scar, and also allows for the assessment of myocardial ischemia. The purpose of this study was to determine the association between the carotid IMT and stress CMR abnormalities including myocardial scar and stress-induced ischemia in asymptomatic diabetic mellitus (DM) patients.
Methods: One hundred and one asymptomatic type 2 DM patients without a history of CAD who underwent both B-mode ultrasound and cardiac MRI were retrospectively investigated. Maximum IMT was determined in the left and right common carotid arteries. Stress-rest perfusion CMR and late gadolinium enhanced (LGE) CMR were performed with a 1.5T MR system to determine the presence or absence of myocardial scar and stress induced ischemia.
Results: CMR revealed myocardial scar in 30 (30%) and stress induced ischemia in 49 (49%) of 101 subjects. Maximum IMT was 2.70 ± 1.25mm in patients with myocardial ischemia and 2.95 ± 1.25mm in patients with myocardial scar, being significantly higher than that in patients with normal CMR (1.65 ± 0.85mm, P < 0.001 and P < 0.001). The area under the receiver operating characteristics (ROC) curve of maximum IMT for predicting presence of myocardial scar on CMR was 0.81 (95% CI 0.71 to 0.92). The area under the ROC curve of maximum IMT was 0.73 (95% CI 0.62 to 0.84) for the prediction of myocardial ischemia on stress CMR. Multivariate analysis revealed maximum IMT is a significant predictor of myocardial scar on CMR with an odds ratio of 2.4 (P<0.001). Although DM duration showed significant univariate association, this relationship was no longer significant with multivariate analysis.
Conclusions: The results in this study indicate that maximum intima media thickness of the carotid artery is strongly associated with myocardial scar detected by CMR in asymptomatic Type 2 diabetic patients. Assessment of IMT appears to be useful in identifying high risk subjects with unrecognized myocardial scars in asymptomatic patients with DM.
- © 2011 by American Heart Association, Inc.