Diabetes and Myocardial Fibrosis: A Systematic Review and Meta-Analysis |
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| Institution: | 1. Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland;2. Graduate School for Health Sciences, University of Bern, Bern, Switzerland;3. Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Switzerland;4. Swiss Paraplegic Research, Notwill, Switzerland;5. Public Health and Primary Care Library, University Library of Bern, University of Bern, Bern, Switzerland;6. University Department of Diabetes, Endocrinology, Nutritional Medicine, and Metabolism, Inselspital, Bern University Hospital, Bern, Switzerland;7. Department for Biomedical Research, Faculty of Medicine, University of Bern, Bern, Switzerland;8. Section on Genetics and Epidemiology, Research Division, Joslin Diabetes Center, Boston, Massachusetts, USA;9. Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA |
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| Abstract: | ObjectivesThis systematic review and meta-analysis investigated the association of diabetes and glycemic control with myocardial fibrosis (MF).BackgroundMF is associated with an increased risk of heart failure, coronary artery disease, arrhythmias, and death. Diabetes may influence the development of MF, but evidence is inconsistent.MethodsThe authors searched EMBASE, Medline Ovid, Cochrane CENTRAL, Web of Science, and Google Scholar for observational and interventional studies investigating the association of diabetes, glycemic control, and antidiabetic medication with MF assessed by histology and cardiac magnetic resonance (ie, extracellular volume fraction ECV%] and T1 time).ResultsA total of 32 studies (88% exclusively on type 2 diabetes) involving 5,053 participants were included in the systematic review. Meta-analyses showed that diabetes was associated with a higher degree of MF assessed by histological collagen volume fraction (n = 6 studies; mean difference: 5.80; 95% CI: 2.00-9.59) and ECV% (13 studies; mean difference: 2.09; 95% CI: 0.92-3.27), but not by native or postcontrast T1 time. Higher glycosylated hemoglobin levels were associated with higher degrees of MF.ConclusionsDiabetes is associated with higher degree of MF assessed by histology and ECV% but not by T1 time. In patients with diabetes, worse glycemic control was associated with higher MF degrees. These findings mostly apply to type 2 diabetes and warrant further investigation into whether these associations are causal and which medications could attenuate MF in patients with diabetes. |
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| Keywords: | CMR T1 mapping diabetes glycosylated hemoglobin meta-analysis myocardial extracellular matrix myocardial fibrosis CVF"} {"#name":"keyword" "$":{"id":"kwrd0045"} "$$":[{"#name":"text" "_":"collagen volume fraction ECV%"} {"#name":"keyword" "$":{"id":"kwrd0055"} "$$":[{"#name":"text" "_":"extracellular volume fraction glycosylated hemoglobin HF"} {"#name":"keyword" "$":{"id":"kwrd0075"} "$$":[{"#name":"text" "_":"heart failure MF"} {"#name":"keyword" "$":{"id":"kwrd0085"} "$$":[{"#name":"text" "_":"myocardial fibrosis WMD"} {"#name":"keyword" "$":{"id":"kwrd0095"} "$$":[{"#name":"text" "_":"weighted mean difference |
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