Meta-analysis of CMR biomarkers in diabetes shows elevated ECV and reduced perfusion
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Key Takeaway
Consider that CMR biomarkers show myocardial changes in diabetes, but evidence is observational.
This is a systematic review and meta-analysis of cardiac magnetic resonance (CMR) biomarkers in patients with diabetes mellitus. The scope was to synthesize evidence on extracellular volume fraction (ECV), myocardial perfusion reserve index (MPRI), and late gadolinium enhancement (LGE).
The authors found that ECV was significantly elevated, with a pooled standardized mean difference (SMD) of 0.838 (p = 0.003). MPRI was reduced, with an SMD of 1.48 (p = 0.033). LGE showed a higher prevalence, with an SMD of 0.583; the p-value was not reported.
The analysis included over 3,900 patients. The authors did not report specific study settings, follow-up durations, or primary outcomes. Safety data and funding conflicts were not reported.
Limitations noted by the authors include the observational nature of the included studies, which precludes causal inference. The review does not report absolute event rates or clinical outcomes.
Clinicians can consider these biomarker alterations as potential indicators of myocardial involvement in diabetes, but the findings require validation in prospective studies.
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View Original Abstract ↓
BackgroundCardiovascular disease (CVD) is the leading cause of morbidity and mortality in diabetes mellitus (DM). Cardiac magnetic resonance (CMR) biomarkers, such as T1 mapping, extracellular volume fraction (ECV), and perfusion indices, have emerged as promising tools for early detection of cardiovascular complications in diabetes.MethodsWe searched for original studies in PubMed, Scopus, Embase, ScienceDirect, and Google Scholar. Included studies enrolled patients with diabetes and were assessed using CMR biomarkers for diagnostic or prognostic outcomes. We extracted data related to study design, study population, CMR techniques, CMR biomarkers, and clinical outcomes. Random-effects meta-analyses were performed for outcomes reported in ≥2 studies.ResultsNineteen studies (n = 3,900+ patients) met inclusion criteria. CMR revealed subclinical myocardial changes in diabetic patients, including higher ECV, reduced strain, impaired perfusion, and increased prevalence of late gadolinium enhancement (LGE). Meta-analysis confirmed significantly elevated ECV (SMD = 0.838, p = 0.003), reduced myocardial perfusion reserve index (MPRI, SMD = 1.48, p = 0.033), and higher prevalence of LGE (SMD = 0.583, p
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