Prognostic Significance of Unrecognized Myocardial Infarction Detected with MR Imaging in Patients with Impaired Fasting Glucose Compared with Those with Diabetes

OBJECTIVES: To investigate whether the presence of myocardial infarction (MI) detected with late gadolinium-enhanced magnetic resonance (MR) imaging is an independent predictor of major adverse cardiac events (MACEs) in patients with impaired fasting glucose (IFG) and those with overt diabetes mellitus (DM).

METHODS: Institutional review board approval was obtained for this study, and all subjects provided written informed consent. Late gadolinium-enhanced and cine MR imaging were performed in 190 patients with IFG and 160 patients with DM without known previous MI to evaluate the presence and extent of late gadolinium enhancement as well as global and regional left ventricular function. MACEs were defined as cardiac death, MI, unstable angina, heart failure, and ventricular arrhythmia. The Cox proportional hazards model was used to investigate the relationship between clinical and MR imaging variables and MACEs.

RESULTS: Follow-up information was obtained in 181 of the 190 patients with IFG (95%) and 151 of the 160 patients with DM (94%). MACEs were observed in 15 of the 181 patients with IFG (8.3%) and 24 of the 151 with DM (15.9%). Late gadolinium enhancement was an independent predictor for MACE in both the IFG group (adjusted hazard ratio, 5.186; P = .003) and DM group (adjusted hazard ratio, 3.229; P = .015). MACE-free survival was significantly higher in patients with IFG than in those with DM (P = .019, log-rank test). However, the MACE-free survival curve for patients with IFG and late gadolinium enhancement was similar to that for patients with DM and late gadolinium enhancement (P = .735).

CONCLUSIONS: The presence of MI detected with late gadolinium-enhanced MR imaging is the strongest multivariable predictor of adverse cardiac events in patients with IFG. Late gadolinium-enhanced MR imaging may help identify a subpopulation of subjects in the prediabetic stage who may benefit from more intensive treatments. Rashaan Evans Jersey

PMID: 22274838

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