Diabetic patients had higher native T1 (1142 vs 1132 ms) and worse GLS (-13.5% vs -15.9%), both independently predicted mortality or heart failure hospitalization.
Do CMR-derived T1, T2, and GLS parameters differ between diabetic and non-diabetic patients, and do they predict all-cause mortality and heart failure hospitalization?
Diabetic patients exhibit higher native T1 and worse global longitudinal strain on CMR compared to non-diabetics, and both parameters independently predict all-cause mortality and heart failure hospitalization.
Abstract Background and aims Cardiovascular events are the leading cause of death in diabetes mellitus (DM), with insulin resistance and obesity driving chronic inflammation and fibrosis of the myocardium. Cardiac magnetic resonance (CMR) provides comprehensive information about tissue characteristics (T1 and T2 mapping) and contractile function (global longitudinal strain (GLS)). This study sought to find differences in myocardial fibrosis (T1) and inflammation (T2) as well as GLS and evaluate their prognostic significance in diabetic and non diabetic patients. Methods Patients undergoing CMR were enrolled in a single-center tertiary care registry including a 1-year follow-up. DM was defined as HbA1c 6.5% if available or based on electronic health records. CMR-derived functional and tissue parameters were compared between groups and adjusted for baseline differences in LV ejection fraction (LV-EF), LV end-systolic volume index (LV-ESVi), and late gadolinium enhancement (LGE) mass. The prognostic significance of the presence of diabetes mellitus and CMR parameters for the combined endpoint of all-cause mortality and heart failure hospitalization was assessed using uni- and multivariable Cox regression. Results 3,868 patients were enrolled of which 708 (18.3%) had DM. After adjusting for baseline differences, DM patients exhibited higher T1 values (1142 ± 69 ms vs. 1132 ± 62 ms, p 0.001), increased myocardial mass (60 ± 20 g/m² vs. 56 ± 20 g/m², p 0.001), worse GLS (-13.5 ± 5.1% vs. -15.9 ± 5.0%, p 0.001), and slightly elevated T2 times (p = 0.032). In a multivariable model including DM, nt-pro-BNP and LGE-mass, T1 (HR 1.004, p = 0.0179), GLS (HR 1.081, p = 0.011), and DM (HR 2.581, p = 0.002) remained independent prognosticators. Both native T1 (categoricalnri = 0.17, p = 0.09; idi = 0.016, p = 0.003) and GLS (categoricalnri = 0.21, p = 0.02; idi = 0.006, p = 0.002) added significantly to the baseline model. Conclusions Diabetic patients have higher native T1 and lower GLS than non-diabetic patients when controlled for LVEF, LVEDV and LGE mass. Both are independently predictive of the combined endpoint of all-cause mortality and heart failure admission, significantly enhancing the predictive power of the baseline model, and could be integrated into cardiovascular risk stratification in diabetic patients to facilitate early identification and targeted therapy.
Treiber et al. (2025) studied this question. Diabetic patients had higher native T1 (1142 vs 1132 ms) and worse GLS (-13.5% vs -15.9%), both independently predicted mortality or heart failure hospitalization.