Abstract 16435: Myocardial Structural Remodeling and Tissue Composition by Cardiac Magnetic Resonance (CMR) in Relation to Metabolic Syndrome in Type 1 Diabetes: The DCCT/EDIC Study

Abstract

INTRODUCTION: CMR is the gold standard for assessing left ventricular (LV) structure and function and has the potential to determine changes in myocardial tissue composition (e.g. change in myocardial fibrosis or lipid content) using T1 mapping. Our aim was to determine the relationship of CMR indices to metabolic syndrome (MetS) and glycemic control in patients with type 1 diabetes mellitus (T1DM).

METHODS: 978 subjects of the Diabetes Control and Complications Trial (DCCT)/Epidemiology of Diabetes Interventions and Complications (EDIC) T1DM cohort (mean age 49 years, 47% female, mean diabetes duration 28 years) had CMR and available MetS data. In a subset of 200 patients, Look Locker sequence was acquired using Siemens 1.5T scanners after gadopentetate dimeglumine administration. MetS was defined as diabetes plus 2 other abnormalities (elevated waist circumference, triglycerides, blood pressure or reduced high density lipoprotein) based on the AHA/NCEP criteria. Associations of MetS with LV indices including myocardial post-contrast T1 times were assessed using multivariate regression models. RESULTS: The prevalence of MetS was 34.1% with no significant gender difference (p=0.45). The mean myocardial T1 time was 440.0±59.1 milliseconds (ms) in women and 478.1±49.2 ms in men (p<0.0001). Participants with MetS had significantly higher end-diastolic volume (EDV, + 5.5 ml), stroke volume (+3.1 ml), LV mass (LVM, +12.3 g), LVM/EDV ratio (+0.05 g/ml) and lower myocardial T1 times (-29.4 ms) compared to those without MetS in the multivariate models (TABLE). Elevated waist circumference showed strongest associations with LV mass and volumes and was the only individual component of MetS showing significant association with T1 time.

CONCLUSION: MetS in T1DM patients was associated with adverse myocardial structural remodeling which may in part explained by presence of interstitial fibrosis and/or lipid content as represented by lower myocardial T1 time by CMR.