Cardiac magnetic resonance for asymptomatic patients with type 2 diabetes and cardiovascular high risk (CATCH): a pilot study.

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  • Additional Information
    • Source:
      Publisher: BioMed Central Country of Publication: England NLM ID: 101147637 Publication Model: Electronic Cited Medium: Internet ISSN: 1475-2840 (Electronic) Linking ISSN: 14752840 NLM ISO Abbreviation: Cardiovasc Diabetol Subsets: MEDLINE
    • Publication Information:
      Original Publication: London : BioMed Central, [2002-
    • Subject Terms:
      Coronary Circulation* ; Magnetic Resonance Imaging, Cine*; Coronary Artery Disease/*diagnostic imaging ; Diabetes Mellitus, Type 2/*epidemiology ; Myocardial Infarction/*diagnostic imaging ; Myocardial Perfusion Imaging/*methods; Adenosine/administration & dosage ; Aged ; Aged, 80 and over ; Asymptomatic Diseases ; Case-Control Studies ; Coronary Angiography ; Coronary Artery Disease/epidemiology ; Coronary Artery Disease/physiopathology ; Coronary Artery Disease/therapy ; Diabetes Mellitus, Type 2/diagnosis ; Feasibility Studies ; Female ; Hong Kong/epidemiology ; Humans ; Male ; Middle Aged ; Myocardial Infarction/epidemiology ; Myocardial Infarction/physiopathology ; Myocardial Infarction/therapy ; Percutaneous Coronary Intervention/instrumentation ; Pilot Projects ; Predictive Value of Tests ; Prevalence ; Prospective Studies ; Reproducibility of Results ; Risk Assessment ; Risk Factors ; Stents ; Time Factors ; Treatment Outcome ; Vasodilator Agents/administration & dosage
    • Abstract:
      Background: Stress cardiovascular magnetic resonance (CMR) to screen for silent myocardial ischaemia in asymptomatic high risk patients with type 2 diabetes mellitus (DM) has never been performed, and its effectiveness is unknown. Our aim was to determine the feasibility of a screening programme using stress CMR by obtaining preliminary data on the prevalence of silent ischaemia caused by obstructive coronary artery disease (CAD) and quantify myocardial perfusion in asymptomatic high risk patients with type 2 diabetes.
      Methods: In this prospective cohort study, we recruited 63 asymptomatic DM patients (mean age 66 years ± 4.4 years; 77.8% male); with Framingham risk score ≥ 20% from 3 sites from June 2017 to August 2018. Normal volunteers were recruited to determine normal global myocardial perfusion reserve index (MPRI). Adenosine stress CMR and global MPRI was performed and measured in all subjects. Positive stress CMR cases were referred for catheter coronary angiography (CCA) with/without fractional flow reserve (FFR) measurements. Positive CCA was defined as an FFR ≤ 0.8 or coronary narrowing ≥ 70%. Patients were followed up for major adverse cardiovascular events. Prevalence is presented as patient numbers and percentage. Mann-Whitney U test was used to compare global MPRI between patients and normal volunteers.
      Results: 13 patients had positive stress CMR with positive CCA (20.6% of patient population), while 9 patients with positive stress CMR examinations had a negative CCA. 5 patients (7.9%) had infarcts detected of which 2 patients had no stress perfusion defects. 12 patients had coronary artery stents inserted, whilst 1 patient declined stent placement. DM patients had lower global MPRI than normal volunteers (n = 7) (1.43 ± 0.27 vs 1.83 ± 0.31 respectively; p < 0.01). After a median follow-up of 653 days, there was no death, heart failure, acute coronary syndrome hospitalisation or stroke.
      Conclusion: 20.6% of asymptomatic DM patients (with Framingham risk ≥ 20%) had silent obstructive CAD. Furthermore, asymptomatic patients have reduced global MPRI than normal volunteers.
      Trial Registration: ClinicalTrials.gov Registration Number: NCT03263728 on 28th August 2017; https://clinicaltrials.gov/ct2/show/NCT03263728.
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    • Contributed Indexing:
      Keywords: Asymptomatic; High cardiovascular risk; Screening; Stress cardiac magnetic resonance; Type 2 diabetes
    • Molecular Sequence:
      ClinicalTrials.gov NCT03263728
    • Accession Number:
      0 (Vasodilator Agents)
      K72T3FS567 (Adenosine)
    • Publication Date:
      Date Created: 20200403 Date Completed: 20200825 Latest Revision: 20200825
    • Publication Date:
      20221213
    • Accession Number:
      PMC7110673
    • Accession Number:
      10.1186/s12933-020-01019-2
    • Accession Number:
      32234045