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Oral Abstract

Oral Abstract Clinical #1- Advancing Patient Care

Effect of metformin on myocardial fibrosis and cardiac function in Duchenne muscular dystrophy: a longitudinal cohort study using cardiovascular magnetic resonance

Thursday, January 30, 2025
11:40 AM – 11:50 AM East Coast USA Time
Location: Diplomat Ballroom

    Presenting Author(s)

  • XZ

    Xinyuan Zhang, Dr

    Doctor
    Department of Radiology, Key Laboratory of Obstetric and Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, West China Second University Hospital, Sichuan University, 20# Section 3 South Renmin Road, Chengdu 610041, China, China (People's Republic)

    • Primary Author(s)

  • XZ

    Xinyuan Zhang, Dr

    Doctor
    Department of Radiology, Key Laboratory of Obstetric and Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, West China Second University Hospital, Sichuan University, 20# Section 3 South Renmin Road, Chengdu 610041, China, China (People's Republic)

    • Co-Author(s)

  • YG

    Yingkun Guo, PhD

    Dr
    West China Second University Hospital, China (People's Republic)

  • Huayan Xu, PhD

    Doctor
    West China Sencond University Hospital, Sichuan University, China (People's Republic)

Background: Interventions delaying the progression of myocardial fibrosis (MF) and cardiac function could affect survival in Duchenne muscular dystrophy (DMD). Metformin plays a cardioprotective role in patients without diabetes; however, its potential value in DMD is unknown. This study aimed to estimate the effects of metformin in patients with DMD.

Methods: This observational cohort study included patients with DMD who received metformin regularly and underwent two cardiac magnetic resonance (CMR) studies with one-year interval between July 2018 and June 2023. The same number of age-matched patients with DMD who had never received metformin as a control group. The primary outcome was late gadolinium enhancement accumulation progression from baseline to follow-up CMR. The second outcome was the left ventricular ejection fraction change between the two CMRs. After adjusting for confounding factors, we used a multivariate generalized linear regression model (GLM) to assess the association between baseline variables and outcomes.

Results:

 A total of 43 boys (median=9.0 years) as metformin group and 43 boys (median=8.0 years) as control group were included in the study. After a median follow-up of 12.0 and 12.6 months, 17 (39.5%) and 19 (44.2%) participants in the metformin and control cohorts reached the outcome of MF progression, respectively. Additionally, 23 (53.5%) and 35 (81.4%) participants reached the cardiac function progression endpoint, respectively. Among patients receiving cardiac medications without cardiac dysfunction, MF progression increased significantly in the control group (10.94% [IQR: 7.75 to 13.30%], P=0.018) but not in the metformin group (1.60% [IQR: -0.91 to 5.07%], P=0.260). Similar findings were observed in the progression of cardiac function in patients without left ventricular dysfunction, regardless of cardiac medications use. Multivariate GLMs, adjusted for confounding factors, showed that metformin use was independently associated with myocardial fibrosis and cardiac function progression.

Conclusion: Early metformin therapy before cardiac dysfunction, initiated with good myocardial conditions, seems to benefit patients with Duchenne muscular dystrophy. These effects encourage further large-scale investigations of DMD and aid clinicians in providing early additional interventions for patients.

Overview of study methodology and findings. LGE= late gadolinium enhancement; LVEF= left ventricular ejection fraction.

Flowchart of the study. Abbreviations: CMR= cardiac magnetic resonance; LVEF= left ventricular ejection fraction.