Our data show that elderly patients with DM without dementia have accelerated progression of brain atrophy with significant consequences in cognition compared to subjects without DM. Our findings add further evidence to the hypothesis that diabetes exerts deleterious effects on neuronal integrity.

Background-Diabetic patients have increased interstitial myocardial fibrosis on histological examination. Magnetic resonance imaging (MRI) T 1 mapping is a previously validated imaging technique that can quantify the burden of global and regional interstitial fibrosis. However, the association between MRI T 1 mapping and subtle left ventricular (LV) dysfunction in diabetic patients is unknown. Methods and Results-Fifty diabetic patients with normal LV ejection fraction (EF) and no underlying coronary artery disease or regional macroscopic scar on MRI delayed enhancement were prospectively recruited. Diabetic patients were compared with 19 healthy controls who were frequency matched in age, sex and body mass index. There were no significant differences in mean LV end-diastolic volume index, end-systolic volume index and LVEF between diabetic patients and healthy controls. Diabetic patients had significantly shorter global contrast-enhanced myocardial T 1 time (425Ϯ72 ms vs. 504Ϯ34 ms, PϽ0.001). There was no correlation between global contrast-enhanced myocardial T 1 time and LVEF (rϭ0.14, Pϭ0.32) in the diabetic patients. However, there was good correlation between global contrast-enhanced myocardial T 1 time and global longitudinal strain (rϭϪ0.73, PϽ0.001). Global contrast-enhanced myocardial T 1 time was the strongest independent determinant of global longitudinal strain on multivariate analysis (standardized ␤ϭϪ0.626, PϽ0.001). Similarly, there was good correlation between global contrast-enhanced myocardial T 1 time and septal EЈ (rϭ0.54, PϽ0.001). Global contrast-enhanced myocardial T 1 time was also the strongest independent determinant of septal EЈ (standardized ␤ϭ0.432, PϽ0.001). Conclusions-A shorter global contrast-enhanced myocardial T 1 time was associated with more impaired longitudinal myocardial systolic and diastolic function in diabetic patients. (Circ Cardiovasc Imaging. 2012;5:51-59.)

ObjectiveTo evaluate, with the use of magnetic resonance imaging (MRI), whether aortic pulse wave velocity (PWV) is associated with cardiac left ventricular (LV) function and mass as well as with cerebral small vessel disease in patients with type 1 diabetes mellitus (DM).Materials and methodsWe included 86 consecutive type 1 DM patients (49 male, mean age 46.9 ± 11.7 years) in a prospective, cross-sectional study. Exclusion criteria included aortic/heart disease and general MRI contra-indications. MRI of the aorta, heart and brain was performed for assessment of aortic PWV, as a marker of aortic stiffness, systolic LV function and mass, as well as for the presence of cerebral white matter hyperintensities (WMHs), microbleeds and lacunar infarcts. Multivariate linear or logistic regression was performed to analyse the association between aortic PWV and outcome parameters, with covariates defined as age, gender, mean arterial pressure, heart rate, BMI, smoking, DM duration and hypertension.ResultsMean aortic PWV was 7.1 ± 2.5 m/s. Aortic PWV was independently associated with LV ejection fraction (ß = -0.406, P = 0.006), LV stroke volume (ß = -0.407, P = 0.001), LV cardiac output (ß = -0.458, P = 0.001), and with cerebral WMHs (P < 0.05). There were no independent associations between aortic stiffness and LV mass, cerebral microbleeds or lacunar infarcts.ConclusionAortic stiffness is independently associated with systolic LV function and cerebral WMHs in patients with type 1 DM.

Aortic arch stiffness is associated with LV mass and lacunar brain infarcts in hypertensive patients, independent of age, sex, and hypertension duration; these manifestations of end-organ damage may help to risk stratify hypertensive patients.

OBJECTIVETo identify vascular mechanisms of brain atrophy in type 1 diabetes mellitus (DM) patients by investigating the relationship between brain volumes and cerebral perfusion and aortic stiffness using magnetic resonance imaging (MRI).RESEARCH DESIGN AND METHODSApproval from the local institutional review board was obtained, and patients gave informed consent. Fifty-one type 1 DM patients (30 men; mean age 44 ± 11 years; mean DM duration 23 ± 12 years) and 34 age- and sex-matched healthy control subjects were prospectively enrolled. Exclusion criteria comprised hypertension, stroke, aortic disease, and standard MRI contraindications. White matter (WM) and gray matter (GM) brain volumes, total cerebral blood flow (tCBF), total brain perfusion, and aortic pulse wave velocity (PWV) were assessed using MRI. Multivariable linear regression analysis was used for statistics, with covariates age, sex, mean arterial pressure, BMI, smoking, heart rate, DM duration, and HbA1c.RESULTSBoth WM and GM brain volumes were decreased in type 1 DM patients compared with control subjects (WM P = 0.04; respective GM P = 0.03). Total brain perfusion was increased in type 1 DM compared with control subjects (β = −0.219, P < 0.05). Total CBF and aortic PWV predicted WM brain volume (β = 0.352, P = 0.024 for tCBF; respective β = −0.458, P = 0.016 for aortic PWV) in type 1 DM. Age was the independent predictor of GM brain volume (β = −0.695, P < 0.001).CONCLUSIONSType 1 DM patients without hypertension showed WM and GM volume loss compared with control subjects concomitant with a relative increased brain perfusion. Total CBF and stiffness of the aorta independently predicted WM brain atrophy in type 1 DM. Only age predicted GM brain atrophy.