Diabetic cardiomyopathy: Pathophysiology, theories and evidence to date

Table 2 Magnetic resonance imaging studies looking at left ventricular mass and concentric remodelling in diabetes

Study details (Author, Year)	Sample population	Exclusion criteria	Main findings
Ng et al[91], 2012	n = 69	Age < 18 yr, arrhythmia, CAD, MI, RWMA, segmental LGE, EF < 50%, valve disease	No difference between groups for LVEDVI, LVESVI, LVMI, LVEF.
	DMs (n = 50, 35 T1DM) Mean age 51 ± 10 yr, 54% males. BMI 26.3 ± 3.7
	Controls (n = 19), matched for age (45 ± 15), sex (63.2% males) an BMI 26.1 ± 4.4
Wilmot et al[93], 2014	T2D n = 20, mean age 31.8 ± 6.6, BMI 33.9 ± 5.8 kg/m2	Weight > 150 kg, contraindications to MRI. In diabetic group BMI > 30 (> 27.5 in South Asians)	↑ LVM (85.2 vs 80.8 g, jP = 0.002) and LVM/Volume (0.54 vs 0.45 g/m2, kP = 0.029) in participants with diabetes compared to lean controls. No significant difference in LVMI
	Lean Controls: n = 10, Mean age 30.9 ± 5.6, Mean BMI 33.4 ± 2.4, 60% males
	Obese Controls: n = 10, Mean age 30.0 ± 6.7, Mean BMI 21.9 ± 1.7, 50% males
Larghat et al[10], 2014	T2DM: n = 19 Mean age 59 ± 6, 68% males, BMI 30.81 ± 4.6	Coronary artery Stenosis > 30% luminal narrowing on angiography, previous MI, significant heart disease, contraindications to MRI or adenosine	↑ LVM (112.8 ± 39.7 vs 91.5 ± 21.3 g, lP = 0.01) in participants with diabetes. Participants with diabetes also showed an increase in LVEDV and SV, but non indexed
	Pre-DM: n = 30 Mean age 57 ± 8, 43% males, BMI 30.1 ± 5.0
	Non DM: n = 46, Mean age 57 ± 7, 41% male, BMI 29 ± 4.9
Levelt et al[62], 2016	T2DM: n = 39, Mean age 55 ± 9, 58% males, BMI 28.7 ± 5.6	History of CVD, chest pain, smoker, uncontrolled hypertension, contraindications to MRI, ischaemia on ECG, renal dysfunction, insulin use, significant CAD on CTCA	EF, LVM, LVMI, no significant difference between groups.
	Controls: n = 17, Mean age 50 ± 14 yr		← LVM/Volume (0.98 ± 0.21 vs 0.70 ± 0.12, mP < 0.001), LVDEV (125 ± 30 mL vs 161 ± 39 mL, nP = 0.001) and lower SV in diabetes
	53% males, BMI 27.1 ± 5.0

IT: Insulin therapy; OT: Oral therapy; BMI: Body mass index; CAD: Coronary artery disease; MI: Myocardial infarction; RWMA: Regional wall motion abnormality; LVEDVI: Left ventricular end diastolic volume index; LVESVI: Left ventricular end systolic volume index; LVMI: Left ventricular mass index; LVEF: Left ventricular ejection fraction.