Prevalence and prognostic significance of reduced myocardial perfusion reserve in diabetic heart failure with preserved ejection fraction using quantitative perfusion cardiac magnetic resonance

Yang Yang; Donglu Qin; Chenyu Li; Leting Tang; Shuai Wang; Xiaoman Chen; Daoquan Peng; Mu Zeng; Bilian Yu

doi:10.1007/s00330-025-11474-8

Prevalence and prognostic significance of reduced myocardial perfusion reserve in diabetic heart failure with preserved ejection fraction using quantitative perfusion cardiac magnetic resonance

Eur Radiol. 2025 Mar 5. doi: 10.1007/s00330-025-11474-8. Online ahead of print.

Authors

Yang Yang¹, Donglu Qin¹, Chenyu Li¹, Leting Tang^{2

3}, Shuai Wang¹, Xiaoman Chen¹, Daoquan Peng¹, Mu Zeng^{4

5}, Bilian Yu^{6

7

8}

Affiliations

¹ Department of Cardiovascular Medicine, The Second Xiangya Hospital, Research Institute of Blood Lipid and Atherosclerosis, Central South University, No. 139 Middle Renmin Road, Changsha, 410011, Hunan, China.
² Department of Radiology, The Second Xiangya Hospital, Central South University, No. 139 Middle Renmin Road, Changsha, 410011, Hunan, China.
³ Clinical Research Center for Medical Imaging in Hunan Province, Changsha, China.
⁴ Department of Radiology, The Second Xiangya Hospital, Central South University, No. 139 Middle Renmin Road, Changsha, 410011, Hunan, China. zengmu@csu.edu.cn.
⁵ Clinical Research Center for Medical Imaging in Hunan Province, Changsha, China. zengmu@csu.edu.cn.
⁶ Department of Cardiovascular Medicine, The Second Xiangya Hospital, Research Institute of Blood Lipid and Atherosclerosis, Central South University, No. 139 Middle Renmin Road, Changsha, 410011, Hunan, China. yubilian@csu.edu.cn.
⁷ Hunan Key Laboratory of Cardiometabolic Medicine, No. 139 Middle Renmin Road, Changsha, 410011, Hunan, China. yubilian@csu.edu.cn.
⁸ FuRong Laboratory, Changsha, 410078, Hunan, China. yubilian@csu.edu.cn.

PMID: 40045071
DOI: 10.1007/s00330-025-11474-8

Abstract

Objectives: To use cardiac magnetic resonance (CMR) to quantify coronary microvascular function, explore the relationship between perfusion and fibrosis, and assess the impact of coronary microvascular dysfunction (CMD) on adverse clinical outcomes.

Materials and methods: In a prospective, observational study, patients with type 2 diabetes mellitus (T2DM) and heart failure were recruited alongside control subjects. Participants underwent clinical assessment and CMR, which included T1 mapping, extracellular volume mapping, as well as measurement of myocardial blood flow at rest and during maximal hyperaemia. Primary outcomes were all-cause death or hospitalization with a cardiovascular cause.

Results: Of 202 participants included, 55 T2DM patients were categorized as heart failure with preserved ejection fraction (DM-HFpEF), 70 as heart failure with ejection fraction less than 50% (DM-HFrEF/HFmrEF), 42 as T2DM control subjects (DM-control) and 35 as asymptomatic control group. DM-HFpEF group exhibited a comparatively diminished myocardial perfusion reserve (MPR) than other three cohorts (all p < 0.05). Reduced MPR (< 2.0) was present in 81.82% of patients with DM-HFpEF. MPR was associated with cardiac troponin T and diffuse fibrosis. MPR demonstrated independent predictability of adverse outcomes even adjusting for clinical, blood, and imaging parameters. Patients with lower MPR exhibited a higher risk of adverse outcomes.

Conclusions: In symptomatic patients with T2DM, a high prevalence of impaired MPR was observed specifically in individuals with HFpEF. MPR was associated with markers of myocardial injury and fibrosis and was predictive of adverse clinical outcomes. These findings could help identify high-risk patients, leading to more intensive treatment.

Key points: Question Data on cardiac MRI for quantifying myocardial blood flow in diabetic patients with heart failure with preserved ejection fraction are limited. Findings A markedly impaired myocardial perfusion reserve was observed in diabetic patients with heart failure with preserved ejection fraction. Clinical relevance Myocardial blood flow could provide incremental value in the diagnosis and risk stratification in diabetic patients with heart failure with preserved ejection fraction.

Keywords: Diabetes mellitus; Heart failure with preserved ejection fraction; Magnetic resonance imaging; Microcirculation; Myocardial perfusion imaging.

Abstract

Grants and funding