Cardiovascular Magnetic Resonance in Diabetic Patients

Patients with diabetes mellitus are at increased risk of cardiovascular morbidity and mortality as a result of numerous pathophysiological changes, including the following:See Article by Heydari et al In addition, the workup of these patients is challenging because of the high prevalence of advanced disease, various overlapping expression of abnormalities, their rapid progression over time, their atypical presentation (eg, atypical symptoms caused by autonomous neuropathy), and the overweight frequently encountered in patients with type 2 diabetes mellitus, as well as limited exercise capacity because of peripheral vascular disease in ≈30% of patients requiring stress testing.Various techniques are used in clinical practice and research to assess the above named pathologies, leading to a continuous improvement in understanding the natural history and relative importance of different biomarkers for prognosis and risk stratification.Especially, the detection of epicardial coronary artery disease and its prognostic relevance has been an area of discussion given the difficulties to perform exercise testing in these patients, the overlap of significant epicardial coronary artery disease with diffuse coronary artery disease, microvascular disease, and endothelial dysfunction, and the specific difficulties the diabetic population poses on echocardiography and single photon emission computed tomography (SPECT).Echocardiography is frequently the first-line technique in assessing patients with cardiovascular presentations because of its immediate availability. However, in the diabetic population, image quality is frequently suboptimal because of obesity, and exercise echocardiography is often impossible. The need for dobutamine as a pharmacological stressor has been shown to be an independent predictor of adverse outcome.1 Although dobutamine stress echocardiography …