Non-invasive assessment of coronary endothelial function in children and adolescents with type 1 diabetes mellitus using isometric handgrip exercise—MRI: A feasibility study

Abstract

Background Type 1 diabetes mellitus (T1DM) in children and adolescents is associated with significant cardiovascular morbidity and mortality. Early detection of vascular dysfunction is key to patient management yet current assessment techniques are invasive and not suitable for pediatric patient populations. A novel approach using isometric handgrip exercise during magnetic resonance imaging (IHE-MRI) has recently been developed to evaluate coronary endothelial function non-invasively in adults. This project aimed to assess endotheliumdependent coronary arterial response to IHE-MRI in children with T1DM and in age matched healthy controls. Materials and methods Healthy volunteers and children with T1DM (>5 years) were recruited. IHE-MRI cross-sectional coronary artery area measurements were recorded at rest and under stress. Carotid intima media thickness (CIMT) and aortic pulse wave velocity (PWV) were assessed for comparison. Student's t-tests were used to compare results between groups. Results and discussion Seven children with T1DM (3 female, median 14.8 years, mean 14.8 ± 1.9 years) and 16 healthy controls (7 female, median 14.8 years, mean 14.2 ± 2.4 years) participated. A significant increase in stress-induced cross-sectional coronary area was measured in controls

Arterial stiffness indices in children and adolescents with type 1 diabetes mellitus: A meta‐analysis

“…The studies originated from the United States, Australia, Croatia, Estonia, Finland, Greece, Italy, Norway, Poland, Taiwan, and the U.K. and were conducted between 2004 and 2021. In detail, 15 studies containing data on carotidfemoral PWV (cf-PWV) 14,15,17,18,20,[22][23][24]26,[28][29][30][31][32][33] (1698 T1DM patients and 1062 healthy controls), three studies measuring carotidradial PWV (cr-PWV) 17,23,30 (775 T1DM patients and 459 healthy controls), two studies reporting on brachial-ankle PWV (ba-PWV) 17,19 (622 T1DM patients and 262 healthy controls), three studies reporting PWV measured by means of MRI 21,25,27 (138 T1DM patients and 87 healthy controls), six studies with data on AIx 18,24,26,28,29,31,33 (263 T1DM patients and 270 healthy controls), and five studies reporting on augmentation index normalised to a heart rate of 75 (AIx75) 13,[15][16][17]22 (1104 T1DM patients and 576 healthy controls) were identified in the final review. The characteristics of all 21 studies included in the analysis are summarised in Table 1.…”

Randomized Trial of Anti-inflammatory Medications and Coronary Endothelial Dysfunction in Patients With Stable Coronary Disease

“…It may be of interest in future trials to evaluate only subjects with biomarker evidence residual inflammatory risk, as done in the CANTOS trial (4). The MRI-CEF approach can safely detect coronary functional abnormalities in children and adolescents with type I diabetes (35) and thus can be applied to study vascular health and the impact of potential interventions across the lifespan.…”

Is Vasospastic Coronary Disease More Common Than We Realize?

“…In addition, newer noninvasive techniques to test coronary endothelial function using MRI have been studied. 8 , 9 In general, coronary provocative testing is recommended for the workup of MINOCA after careful review of the angiography films (and when available, review of IVUS) and when other diagnostic studies (CMR, echo) do not yield a specific etiology or diagnosis.…”