Multimodality imaging approach to left ventricular dysfunction in diabetes: an expert consensus document from the European Association of Cardiovascular Imaging

European Heart Journal - Cardiovascular Imaging, vol. 23, pp. e62–e84

Abstract

Heart failure (HF) is among the most important and frequent complications of diabetes mellitus (DM). The detection of subclinical dysfunction is a marker of HF risk and presents a potential target for reducing incident HF in DM. Left ventricular (LV) dysfunction secondary to DM is heterogeneous, with phenotypes including predominantly systolic, predominantly diastolic, and mixed dysfunction. Indeed, the pathogenesis of HF in this setting is heterogeneous. Effective management of this problem will require detailed phenotyping of the contributions of fibrosis, microcirculatory disturbance, abnormal metabolism, and sympathetic innervation, among other mechanisms. For this reason, an imaging strategy for the detection of HF risk needs to not only detect subclinical LV dysfunction (LVD) but also characterize its pathogenesis. At present, it is possible to identify individuals with DM at increased risk HF, and there is evidence that cardioprotection may be of benefit. However, there is insufficient justification for HF screening, because we need stronger evidence of the links between the detection of LVD, treatment, and improved outcome. This review discusses the options for screening for LVD, the potential means of identifying the underlying mechanisms, and the pathways to treatment.

Authors 25

1. Thomas Hugh Marwick corresponding

   Baker Heart and Diabetes Institute

   Affiliation as printed

   Baker Heart and Diabetes Institute , 75 Commercial Road , Melbourne, VIC 3004,

   Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, VIC 3004, Australia

2. Alessia Gimelli

   Fondazione Toscana Gabriele Monasterio

   Affiliation as printed

   Fondazione Toscana Gabriele Monasterio , Via Moruzzi, 1 , 56124 Pisa,

   Fondazione Toscana Gabriele Monasterio, Via Moruzzi, 1, 56124 Pisa, Italy

3. Sven Plein

   University of Leeds

   Affiliation as printed

   Multidisciplinary Cardiovascular Research Center & Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds , Leeds,

   Multidisciplinary Cardiovascular Research Center & Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK

4. Jeroen Joost Bax Aachen Department of Cardiology, Leiden University Medical Centre

   Leiden University · Leiden University Medical Center

   Affiliation as printed

   Department of Cardiology, Leiden University Medical Centre (LUMC) , Leiden,

   Department of Cardiology, Leiden University Medical Centre (LUMC), Leiden, The Netherlands

5. Philippe Charron

   Inserm · Sorbonne Université · Assistance Publique – Hôpitaux de Paris · Pitié-Salpêtrière Hospital · Fondation pour l’innovation en Cadiométabolisme et Nutrition

   Affiliation as printed

   APHP, Centre de référence pour les maladies cardiaques héréditaires ou rares, Hôpital Pitié-Salpêtrière , Paris,

   Sorbonne Université, INSERM UMRS 1166 and ICAN Institute , Paris,

   APHP, Centre de référence pour les maladies cardiaques héréditaires ou rares, Hôpital Pitié-Salpêtrière, Paris, France

   Sorbonne Université, INSERM UMRS 1166 and ICAN Institute, Paris, France

6. Victoria Delgado Aachen Department of Cardiology, Leiden University Medical Centre

   Leiden University · Leiden University Medical Center

   Affiliation as printed

   Department of Cardiology, Leiden University Medical Centre , Albinusdreef 2 , Leiden 2300RC,

   Department of Cardiology, Leiden University Medical Centre, Albinusdreef 2, Leiden 2300RC, The Netherlands

7. Erwan Donal

   Laboratoire Traitement du Signal et de l'Image · CIC Rennes · Centre Hospitalier Universitaire de Rennes · Université Rennes 1 · Université de Rennes

   Affiliation as printed

   Service de Cardiologie Et Maladies Vasculaires Et CIC-IT 1414, CHU Rennes , 35000 Rennes,

   Université de Rennes 1, LTSI , 35000 Rennes,

   Service de Cardiologie Et Maladies Vasculaires Et CIC-IT 1414, CHU Rennes, 35000 Rennes, France

   Université de Rennes 1, LTSI, 35000 Rennes, France

8. Patrizio Lancellotti

   University of Liège · Maria Cecilia Hospital · Centre Hospitalier Universitaire de Liège

   Affiliation as printed

   Department of Cardiology, University of Liège Hospital, GIGA Cardiovascular Sciences, CHU SartTilman , Liège,

   Gruppo Villa Maria Care and Research, Maria Cecilia Hospital, Cotignola, and Anthea Hospital , Bari,

   Department of Cardiology, University of Liège Hospital, GIGA Cardiovascular Sciences, CHU SartTilman, Liège, Belgium

   Gruppo Villa Maria Care and Research, Maria Cecilia Hospital, Cotignola, and Anthea Hospital, Bari, Italy

9. Eylem Levelt

   University of Leicester · Glenfield Hospital

   Affiliation as printed

   Department of Cardiovascular Sciences, University of Leicester, Glenfield Hospital   , Groby Road , Leicester LE3 9QF,

   Department of Cardiovascular Sciences, University of Leicester, Glenfield Hospital , Groby Road, Leicester LE3 9QF, UK

10. Pál Maurovich‐Horvat

    Semmelweis University

    Affiliation as printed

    MTA-SE Cardiovascular Imaging Research Group, Medical Imaging Centre, Semmelweis University , 2 Koranyi u ., 1083 Budapest,

    MTA-SE Cardiovascular Imaging Research Group, Medical Imaging Centre, Semmelweis University, 2 Koranyi u., 1083 Budapest, Hungary

11. Stefan Neubauer

    University of Oxford

    Affiliation as printed

    Radcliffe Department of Medicine, University of Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford , Headley Way , Oxford OX3 9DU,

    Radcliffe Department of Medicine, University of Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, Headley Way, Oxford OX3 9DU, UK

12. Gianluca Pontone

    University of Milan · Centro Cardiologico Monzino

    Affiliation as printed

    Centro Cardiologico Monzino IRCCS, University of Milan, Cardiovascular Imaging , Milan,

    Centro Cardiologico Monzino IRCCS, University of Milan, Cardiovascular Imaging, Milan, Italy

13. Antti Saraste

    University of Turku · Turku University Hospital · Turku PET Centre

    Affiliation as printed

    Heart Center, Turku University Hospital , Turku,

    Turku PET Centre, University of Turku , Turku,

    Heart Center, Turku University Hospital, Turku, Finland

    Turku PET Centre, University of Turku, Turku, Finland

14. Bernard Cosyns

    Universitair Ziekenhuis Brussel

    Affiliation as printed

    Cardiology, CHVZ (Centrum voor Hart en Vaatziekten), ICMI (In Vivo Cellular and Molecular Imaging) Laboratory, Universitair ziekenhuis Brussel , 109 Laarbeeklaan , Brussels 1090,

    Cardiology, CHVZ (Centrum voor Hart en Vaatziekten), ICMI (In Vivo Cellular and Molecular Imaging) Laboratory, Universitair ziekenhuis Brussel, 109 Laarbeeklaan, Brussels 1090, Belgium

15. Thor Edvardsen

    Oslo University Hospital · University of Oslo

    Affiliation as printed

    Department of Cardiology, Oslo University Hospital, Rikshospitalet , Postbox 4950 Nydalen, Sognsvannsveien 20 , NO-0424 Oslo,

    Institute for clinical medicine, University of Oslo , Sognsvannsveien 20 , NO-0424 Oslo,

    Department of Cardiology, Oslo University Hospital, Rikshospitalet, Postbox 4950 Nydalen, Sognsvannsveien 20, NO-0424 Oslo, Norway

    Institute for clinical medicine, University of Oslo, Sognsvannsveien 20, NO-0424 Oslo, Norway

16. Bogdan Alexandru Popescu

    Carol Davila University of Medicine and Pharmacy · Institutul de Urgenţă pentru Boli Cardiovasculare "Prof.Dr. C.C. Iliescu"

    Affiliation as printed

    Department of Cardiology, University of Medicine and Pharmacy “Carol Davila”, Euroecolab, Emergency Institute for Cardiovascular Diseases “Prof. Dr. C. C. Iliescu” , Bucharest,

    Department of Cardiology, University of Medicine and Pharmacy "Carol Davila", Euroecolab, Emergency Institute for Cardiovascular Diseases "Prof. Dr. C. C. Iliescu", Bucharest, Romania

17. Maurizio Galderisi

    Federico II University Hospital · University of Naples Federico II

    Affiliation as printed

    Department of Advanced Biomedical Sciences, Federico II University , Naples,

    Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy

18. Geneviève Dérumeaux

    Inserm · Institut Mondor de Recherche Biomédicale

    Affiliation as printed

    IMRB – Inserm U955 Senescence , metabolism and cardiovascular diseases 8, rue du Général Sarrail, 94010 Créteil,

    IMRB – Inserm U955 Senescence, metabolism and cardiovascular diseases 8, rue du Général Sarrail, 94010 Créteil, France

19. Magnus Bäck
20. Philippe B. Bertrand

    University of Leeds

    Affiliation as printed

    Leeds Institute of Cardiovascular and Metabolic Medicine , University of Leeds , Leeds , UK;

21. Marc Richard Dweck

    University of Leeds

    Affiliation as printed

    Leeds Institute of Cardiovascular and Metabolic Medicine , University of Leeds , Leeds , UK;

    Clinical sciences

22. Niall Keenan

    Maria Cecilia Hospital

    Affiliation as printed

    Maria Cecilia Hospital , Cotignola , and Anthea Hospital , Bari , Italy;

23. Julien Magné

    Maria Cecilia Hospital

    Affiliation as printed

    Maria Cecilia Hospital , Cotignola , and Anthea Hospital , Bari , Italy;

    Clinical sciences

24. Danilo Neglia

    University of Leeds

    Affiliation as printed

    Leeds Institute of Cardiovascular and Metabolic Medicine , University of Leeds , Leeds , UK;

25. Ivan Stanković

    University of Leeds

    Affiliation as printed

    Leeds Institute of Cardiovascular and Metabolic Medicine , University of Leeds , Leeds , UK;