Cine Displacement ENcoding imaging with Stimulated Echoes (cine-DENSE) confirms systolic myocardial dysfunction in asymptomatic patients with type 2 diabetes mellitus: comparison with MR-tagging

Abstract

Background: Diabetic cardiomyopathy contributes to increase mortality in patients with diabetes mellitus (DM). A preclinical systolic dysfunction has been suggested in echocardiographic studies but cardiac-MRI (CMR) remains the gold standard for quantification of myocardial deformation. MR-tagging is the most common CMR technique for strain calculation but is intrinsically limited in measuring transmural variations. Cine-DENSE (Displacement Encoding Imaging with Stimulated Echoes) has been recently proposed as an alternative that benefits from an increased spatial resolution. Objective(s): To evaluate whether cine-DENSE and MR-tagging confirm the existence of a sub-clinical myocardial dysfunction in type II DM (T2DM) patients (pts) free of overt heart disease. Method(s): 37 T2DM pts (51+/-6 years, HbA1c 7.6+/-1.2%) and 21 age-matched controls (50+/-8 years) underwent a CMR study on a 1.5 T scanner. Subjects were excluded if standard echocardiography showed significant abnormality. After a standard CMR study for conventional LV function assessment, two-dimensional cine-DENSE pulse sequence and MR-tagging were acquired in short axis views at the same basal, mid and apical levels. LV volumes and ejection fraction (LVEF) were measured on cine-MRI images. Circumferential maximal systolic strain (sc) was calculated from cine-DENSE and MR-tagging acquisitions on 16 LV segments. Average maximal systolic strain in each slice and a whole heart mean value (scmean) for each pt were calculated. Result(s): Standard LV function parameters were normal and comparable between groups (table). Whereas LVEF was similar in the 2 groups, cine-DENSE showed a significant decrease in sc at basal, mid and apical LV levels and in scmean in the T2DM group as compared to controls. MR-tagging confirmed a decrease in sc at the 3 LV levels and in scmean in T2DM patients as compared with controls. Conclusion(s): Cine-DENSE and MR-tagging confirm subclinical myocardial dysfunction in asymptomatic patients with Type II DM(Table presented).