Saskia van Elderen MD, PhD, Presenter: Nothing to Disclose

Jos Westenberg PhD, Abstract Co-Author: Nothing to Disclose

Jan W.A. Smit MD, PhD, Abstract Co-Author: Nothing to Disclose

Lucia J.M. Kroft MD, Abstract Co-Author: Nothing to Disclose

Mark A. Van Buchem MD, PhD, Abstract Co-Author: Research Consultant, Medis Medical Imaging Systems, Inc

Albert De Roos MD, Abstract Co-Author: Nothing to Disclose

Diabetes Mellitus(DM) is known to cause cardiac failure, arterial stiffening and structural brain abnormalities, subsequently increasing the risk of cardiovascular morbidity and mortality. To our knowledge, MRI has not previously been used to simultaneously determine organ damage in the heart, aorta and the brain in patients with DM. Therefore the purpose of this study is to examine the correlation between aortic pulse wave velocity(PWV), as marker of aortic stiffness, left ventricular(LV) function and cerebral white matter lesions(WML) in DM patients using MRI.

As part of an ongoing study, MRI of the heart, aorta and the brain was performed in 26 consecutively included DM patients (14 men; mean age 51±13 years). Short-axis MRI was performed to assess LV systolic function. Transmitral flow measurements were performed by means of velocity-encoded MRI for evaluation of LV diastolic function. PWV (defined as the propagation speed of the systolic wave front) in the aortic arch and the descending aorta were assessed using velocity-encoded MRI. White matter hyperintensities on FLAIR sequences were quantified according to the Fazekas classification.

Systolic function was normal in the study population (ejection fraction:60±7%). PWV in the aortic arch, descending and total aorta correlated inversely with LV diastolic function (E/A peak ratio: resp. Spearman’s rho=-0.730, p<0.001; r =-0.684, p<0.001; r =-0.779, p<0.001; E deceleration peak: resp. r=-0.534, p=0.004; r=-0.524, p=0.005; r= -0.613, p=0.001). PWV in the aortic arch and total aorta correlated with periventricular(pv) and subcortical(sc) WML (pv Fazekas score: resp. r=0.556, p=0.003; r=0.414, p=0.040; sc Fazekas score: resp. r=0.470, p=0.015; r=0.453, p=0.023). Furthermore, using multiple linear regression analysis, PWV in the aortic arch revealed to be an independent predictor of pv Fazekas score (R=0.744, p<0.001) after adjusting for systolic blood pressure and age.

Stiffening of the aorta is associated with left ventricular relaxation impairment and lesions of the cerebral white matter in diabetes mellitus patients. Moreover, PWV of the aortic arch is an independent predictor of periventricular white matter lesions.

Aortic PWV assessed with MRI can be used as a marker for early cardiac and cerebral damage in DM patients, potentially improving cardiovascular risk stratification.

Elderen, S, Westenberg, J, Smit, J, Kroft, L, Van Buchem, M, De Roos, A, Correlation between Aortic Stiffness, Left Ventricular Function, and White Matter Brain Lesions in Diabetes Mellitus as Assessed by MRI.  Radiological Society of North America 2008 Scientific Assembly and Annual Meeting, February 18 - February 20, 2008 ,Chicago IL. http://archive.rsna.org/2008/6011275.html