Assessment of myocardial matrix expansion with cardiac magnetic resonance: entering a new area of cardiac risk stratification in type 2 diabetes mellitus?

This editorial refers to ‘Myocardial extracellular volume fraction quantified by cardiovascular magnetic resonance is increased in diabetes and associated with mortality and incident heart failure admission’[†][1], by T.C. Wong et al. , on page 657 Type 2 diabetes mellitus (DM) may lead not only to early development of accelerated coronary artery disease (CAD) but also to cardiomyopathy (CMP), both of which confer an excess morbidity and mortality in these patients.1–3 As there is a continuous increase in the prevalence of DM in industrialized nations, it raises a considerable public health concern. Subclinical markers of early functional and structural vasculopathy such as an impairment of coronary circulatory function,4 increased carotid intima-media thickeness (IMT),5 and coronary artery calcification6 have all been demonstrated independently to predict the initiation and/or progression of CAD and subsequent cardiovascular events. More recently, cardiovascular magnetic resonance (CMR) assessment of increased extracellular volume (ECV) fraction of the left ventricle, which can be assumed to probe features of adverse myocardial remodelling, predicted mortality and heart failure-related events in an independent fashion in a general cardiovascular risk cohort.7 It is important to consider that, despite the standard use of preventive antidiabetic medication, DM is still associated with a greater coronary atherosclerotic burden, accelerated CAD progression, and CMP manifestation than in those individuals with cardiovascular risk but without a hyperglycaemic state.3,8 This emphasizes the necessity for additional diagnostic and medical therapeutic strategies aiming to prevent or inhibit the progression of diabetes-induced vasculopathy and/or CMP and, thereby, to improve cardiovascular outcome. Nowadays, CMR has evolved as a unique imaging tool to identify and characterize subclinical and clinically manifest alterations of the myocardial tissue. CMR in concert with intravenous use of gadolinium is commonly applied for determining myocardial perfusion with the first-pass technique as well … [1]: #fn-2