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Rapid Fire Abstracts

Rapid Fire 06- Multi-Center Trials and Epidemiological Studies

Diabetic retinopathy is associated with reduced myocardial strain despite preserved left ventricular ejection fraction: UK Imaging Diabetes Study (RF_FR_332)

Friday, January 31, 2025
11:10 AM – 11:20 AM East Coast USA Time
Location: Blue Room PreFunction
Background: Diabetic retinopathy (DR) is an important microvascular complication of T2DM, and can predict the occurrence of CVD, in addition to other non-cardiac organ comorbidities. We sought to evaluate the burden of cardiac abnormalities in patients with T2DM and DR when compared to healthy controls, using a multi-organ magnetic resonance imaging (MRI) of the heart, liver, and pancreas. We hypothesised that patients with DR have increased burden of cardiac abnormalities, in addition to other organ abnormalities. 

Methods: 186 subjects (DR, n=94; healthy controls, n=92) were recruited as part of the UKIDS (UK Imaging Diabetes Study), and COVERSCAN, respectively. T2DM patients without history of CVD underwent eye assessment for stages of retinopathy. Both cohorts underwent a standardised multiorgan multiparametric MRI scan performed on a 3T scanner for the assessments of cardiac function (left ventricular ejection fraction - LVEF, and strain), aortic distensibility, epicardial & pericardial fat, myocardial native T1 mapping, liver fat, liver iron corrected T1 (cT1), pancreatic fat, and pancreatic scanner-referenced T1 (srT1). 

Results:

DR had significantly reduced indexed LV end-diastolic (71 vs 89 ml/gm2, p< 0.001) & LV stroke volumes (41 vs 53 ml/gm2, p< 0.001), impaired global longitudinal (GLS -15 vs -18 %, p< 0.001) & circumferential strains (GCS -18 vs -20 %, p=0.027), increased myocardial T1 (1210 vs 1176 ms, p=0.016), elevated epicardial adipose tissue (10.5 vs 8.2 cm2, p=0.046), and reduced proximal descending aortic distensibility (0.002 vs 0.005 mmHg-1, p< 0.001), when compared to controls. These differences remained significant after adjustment for confounding factors (age, sex and BMI). Although numerically there were increased LV wall thickness, reduced LVEF and elevated pericardial fat in DR, the differences were not significant compared to controls after correction for confounding factors. Correlation analyses demonstrated that reduced GLS correlated with both increased epicardial and pericardial fat, while reduced GCS correlated with increased pericardial fat in DR. Assessment of the liver and pancreas demonstrated significantly elevated cT1 and srT1 levels, respectively in DR patients when compared to controls. After controlling for age, sex and BMI, liver cT1 was independently associated with both epicardial and pericardial fat, but not LV wall thickness or strain.

Conclusion: When compared to healthy controls, patients with DR have subclinical LV systolic dysfunction (impaired strain) despite preserved LVEF, which correlates with elevated epicardial fat and increased liver fibroinflammation. Our findings suggest that patients with T2DM and retinopathy without history of CVD may have underlying cardiac diseases and therefore should be considered for further cardiac evaluation. Comprehensive multi-organ imaging in DR patients for evaluation of cardiac and other organ health would allow risk and therapeutic stratification in these patients.