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. 2025 Aug 23:jeaf249.
doi: 10.1093/ehjci/jeaf249. Online ahead of print.

The role of stress cardiovascular magnetic resonance in patients with Diabetes Mellitus

Mark Hinderks  1 , Solenn Toupin  2   3   4 , Robin Nijveldt  1 , Suzanne Duhamel  5 , Francesca Sanguineti  5 , Thomas Hovasse  5 , Stéphane Champagne  5 , Thierry Unterseeh  5 , Myriam Akodad  5 , Antoinette Neylon  5 , Trecy Gonçalves  2   3   4   6 , Paul-Jun Martial  2   3   4 , Sonia Houssany-Pissot  2   3   4   7 , Emmanuel Gall  2   3   4   5 , Jean Guillaume Dillinger  2   3   4 , Patrick Henry  2   3   4 , Valérie Bousson  7 , Philippe Garot  5 , Peter Damman  1 , Jérôme Garot  5 , Théo Pezel  2   3   4   5   6
Affiliations

The role of stress cardiovascular magnetic resonance in patients with Diabetes Mellitus

Mark Hinderks et al. Eur Heart J Cardiovasc Imaging. .

Abstract

Objectives: The aim of this study was to evaluate the prognostic value of stress perfusion cardiovascular magnetic resonance (CMR) in diabetic versus non-diabetic patients, and then in symptomatic versus asymptomatic diabetics.

Background: Diabetic individuals are at increased risk of coronary atherosclerosis. A significant percentage of diabetics fail to perceive the typical symptoms of myocardial ischemia. Screening methods such as coronary computed tomography (CCTA) or single-photon emission computed tomography (SPECT) have not shown clear benefits in asymptomatic diabetics. The role of stress CMR in this population is not well established.

Methods: Between 2008 and 2018, all consecutive diabetic and non-diabetic patients without known cardiovascular disease referred for stress perfusion CMR in two tertiary centers were included. Propensity-score matching was used to create a cohort of diabetic versus non-diabetic patients with similar baseline characteristics. All patients were followed for the occurrence of major adverse cardiovascular events (MACE), defined as cardiovascular death or non-fatal myocardial infarction. Diabetic patients were categorized into symptomatic and asymptomatic patients.

Results: Out of 3,485 eligible patients, 1,359 diabetics and 1,359 non-diabetics (mean age 69±12 years, 57.4% women) with similar propensity scores were included. Over a median follow-up period of 6.5 (5.9-8.9) years, 386 (14.2%) experienced MACEs. Kaplan-Meier analysis for the occurrence of MACE indicated that the extent of ischemia or late gadolinium enhancement (LGE) involving ≥ 3 segments were independent predictors of the occurrence of MACEs (hazard ratio, HR: 7.14 [95% CI, 5.01-10.02]; and HR: 5.03 [95% CI, 3.47-7.29]; both p<0.001, respectively), with no significant differences between diabetics and non-diabetics. Asymptomatic diabetics (n=255) showed similar event rates as symptomatic patients (p=0.98).

Conclusion: Stress CMR provides valuable prognostic information in diabetic patients, irrespective of symptoms. Further assessment is needed to determine whether stress CMR should be a standard screening tool for diabetic patients.

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