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Observational Study
. 2018 Mar 5;17(1):35.
doi: 10.1186/s12933-018-0681-4.

Cardiovascular magnetic resonance measures of aortic stiffness in asymptomatic patients with type 2 diabetes: association with glycaemic control and clinical outcomes

Peter P Swoboda  1 , Bara Erhayiem  2 , Rachel Kan  2 , Adam K McDiarmid  2 , Pankaj Garg  2 , Tarique A Musa  2 , Laura E Dobson  2 , Klaus K Witte  2 , Mark T Kearney  2 , Julian H Barth  3 , Ramzi Ajjan  2 , John P Greenwood  2 , Sven Plein  2
Affiliations
Observational Study

Cardiovascular magnetic resonance measures of aortic stiffness in asymptomatic patients with type 2 diabetes: association with glycaemic control and clinical outcomes

Peter P Swoboda et al. Cardiovasc Diabetol. .

Abstract

Background: We aimed to investigate in patients with type 2 diabetes whether aortic stiffness is: (i) associated with glycaemic control, (ii) associated with adverse outcomes and (iii) can be reversed on treatment with RAAS inhibition.

Methods: Patients with type 2 diabetes (N = 94) and low vascular risk underwent assessment of cardiovascular risk and CMR assessment of ascending aortic distensibility (AAD), descending aortic distensibility (DAD) and aortic pulse wave velocity (PWV). Of these patients a subgroup with recent onset microalbuminuria (N = 25) were treated with renin-angiotensin-aldosterone system (RAAS) inhibition and imaging repeated after 1 year. All 94 patients were followed up for 2.4 years for major adverse cardiovascular disease (CVD) events including myocardial infarction detected on late gadolinium enhancement CMR.

Results: Ascending aortic distensibility, DAD and PWV all had a significant association with age and 24 h systolic blood pressure but only AAD had a significant association with glycaemic control, measured as HbA1c (Beta - 0.016, P = 0.04). The association between HbA1c and AAD persisted even after correction for age and hypertension. CVD events occurred in 19/94 patients. AAD, but not DAD or PWV, was associated with CVD events (hazard ratio 0.49, 95% confidence interval 0.25-0.95, P = 0.01). On treatment with RAAS inhibition, AAD, but not DAD or PWV, showed significant improvement from 1.51 ± 1.15 to 1.97 ± 1.07 10-3 mmHg-1, P = 0.007.

Conclusions: Ascending aortic distensibility measured by CMR is independently associated with poor glycaemic control and adverse cardiovascular events. Furthermore it may be reversible on treatment with RAAS inhibition. AAD is a promising marker of cardiovascular risk in asymptomatic patients with type 2 diabetes and has potential use as a surrogate cardiovascular endpoint in studies of novel hypoglycaemic agents. Clinical trials registration https://clinicaltrials.gov/ct2/show/NCT01970319.

Keywords: Aortic distensibility; Cardiovascular magnetic resonance; Cardiovascular risk; Pulse wave velocity; Renin–angiotensin–aldosterone.

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Figures

Fig. 1
Fig. 1
Flow chart of patient recruitment
Fig. 2
Fig. 2
Associations of three measures of aortic stiffness in asymptomatic patients with type 2 diabetes
See this image and copyright information in PMC

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