MRI May Effectively Indicate CVD in Diabetics

Print


MRI CVD Diabetics

Researchers have discovered that by using whole body MRI, it is highly likely cardiovascular disease in patients with diabetes can be foretold.

According to Fabian Bamberg, MD, MPH, of Ludwig-Maximilians University in Munich, and his team, patients who presented noticeable vascular changes on whole body MRI had a growing risk of a cardiovascular event of 20% at 3 years, and 35% at 6 years.

However, none of the patients with a regular whole body MRI scan suffered from a cardiac event over that period of time as detailed in the study, published online in the journal Radiology.

"Whole-body MRI may help in identifying patients who are at very high risk for future events and require intensified treatment or observation. Conversely, the absence of any changes on whole-body MRI may reassure diabetic patients that their risk for a heart attack, stroke, or other major cardiac or cerebrovascular event is low,” said Bamberg.

It is a well known fact that patients who have a condition of diabetes are prone to cardiovascular disease. And of late, there has been a surge of supporting evidence that MRI can offer reliable predictive information on cardiovascular outcomes and events. Bamberg highlighted that the imaging system is in no way linked to radiation exposure, and has the ability to evaluate whole-body degree of disease burden that is not clinically apparent yet."

In order to determine its prognostic worth in either case of type 1 or type 2 diabetes, the researchers registered 65 diabetic patients, who had a contrast-enhanced whole body MRI that included brain, cardiac, and vascular cycles.

The main outcome was a combination of significant adverse cardiac and cerebrovascular events (MACCE) which included cardiac-cerebrovascular death, myocardial infarction, cerebrovascular event, or revascularization.

And after an average follow-up period of 5.8 years, it was found that 23% of the patients experienced a MACCE event.

Bamberg and his team discovered that patients with noticeable vascular changes on whole body MRI had a growing MACCE rate of 20% at 3 years and 35% at 6 years. However, those without any noticeable ischemic or atherosclerotic traces had no cardiovascular events over the duration of the study.

"Our results showed that the absence of any finding at whole-body MR imaging excludes events during a relatively long follow-up period," they noted.  

Single-bases analyses showed that patients who did experience an event had a greater incidence of findings at cardiac, carotid, and peripheral vessel imaging, not to mention higher whole body summary findings as opposed to those who did not experience an event.

Yet they warned that analyses attuned to the history of cardiovascular disease discovered that only the existence of myocardial hypokinesis or akinesis with cardiac sequences (P=0.008), not to mention the summary measures (P=0.03 for the number of abnormal territories and P=0.01 for the vessel score), to still be considerably linked to events. 

They also revealed that in further analyses these summarized calculations were constantly discovered to be strong indicators of MACCE, irrespective of demographics and history.

•    Atherosclerotic vessel score: hazard ratio 12.0, 95% CI 2.5-67.3

•    Number of vascular territories with positive findings: HR 3.2, 95% CI 1.4-8.2

“These summary measures are strong predictors that appear to be incremental to established parameters such as the finding of hypokinesia or akinesia as detected at whole-body imaging," said Bamberg.

However, researchers suggest that this single-center study does have its limitations. They noted that "the character of this study is hypothesis generating rather than allowing final conclusions," however the whole body MRI, "may serve as a valuable noninvasive tool for risk stratification in patients with diabetes," especially if accompanying trials on a much lager scale serve to verify their findings.