Aortic stiffness is associated with cardiac function and cerebral small vessel disease in patients with type 1 diabetes mellitus: assessment by magnetic resonance imaging

Abstract

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.

Large-vessel correlates of cerebral small-vessel disease

“…19,28,[30][31][32] Our results lend further support to an association of large-artery stiffness with WMH burden, and extend the findings to markers of carotid stiffness, additionally demonstrating that this association is at least in part independent of carotid atherosclerosis. Markers of carotid stiffness were not associated with LIs in our sample, suggesting that carotid stiffness may have an important role in chronic hypoperfusion but not complete infarction in the territory of small arteries.…”

“…The relationship of pulse wave velocity, a marker of aortic stiffness, with MRI markers of ischemic brain injury was recently assessed, in relatively small samples. 19,[28][29][30][31][32] After accounting for vascular risk factors, pulse wave velocity was consistently associated with WMH burden, [30][31][32] Abbreviations: CCA-IMT 5 common carotid artery intima-media thickness; CI 5 confidence interval; L-WMHV 5 large white matter hyperintensity volume (age-specific top quartile); OR 5 odds ratio (per SD increase); SE 5 standard error; SVD 5 small-vessel disease; WMHV 5 white matter hyperintensity volume. a Log-transformed ratio of WMHV over total white matter volume.…”

Improved aortic pulse wave velocity assessment from multislice two‐directional in‐plane velocity‐encoded magnetic resonance imaging

“…In addition, it maintains the blood supply to the heart (ie, the coronary circulation) and other organs during diastole. Numerous reports have used VE MRI to assess the aortic PWV (8,(13)(14)(15)(20)(21)(22), almost exclusively using the transit-time method with one-directional through-plane velocity-encoding at multiple sites perpendicular to the aorta. Rogers et al (28), Yu et al (29), and Fielden et al (30) assessed PWV from in-plane VE MRI acquisitions.…”

“…Multisite one-directional through-plane velocityencoded (VE) magnetic resonance imaging (MRI) has been applied for PWV assessment by calculating the speed of the flow wave or the velocity wave propagating through the aorta from the distance between measurement sites and the difference in time (ie, the transit time) of the arrival of the wave front at the respective sites (8,(13)(14)(15)(20)(21)(22). The 3D nature of MRI enables an accurate determination of the aortic length without restrictions regarding imaging planes.…”

Arterial stiffness and progression of structural brain changes

“…12 Also, stiffness of the large arteries may impair cerebral autoregulation, predisposing to hypoperfusion during hypotension, subsequently leading to ischemia. 13 Several cross-sectional studies relating arterial stiffness to the subclinical markers of dementia showed a relation between increased arterial stiffness and larger white matter lesion (WML) volumes, [14][15][16][17][18][19][20] more lacunar infarcts, 14,20,21 more brain atrophy, 12,20 and lower cerebral perfusion. 22 However, it is unknown whether arterial stiffness contributes to an increased development of ischemic and degenerative brain changes over time.…”