Diabetes and Myocardial Fibrosis: A Systematic Review and Meta-Analysis

Dante B Salvador Jr; Magda R Gamba; Nathalia Gonzalez-Jaramillo; Valentina Gonzalez-Jaramillo; Peter Francis N Raguindin; Beatrice Minder; Christoph Gräni; Matthias Wilhelm; Christoph Stettler; Alessandro Doria; Oscar H Franco; Taulant Muka; Arjola Bano

doi:10.1016/j.jcmg.2021.12.008

Diabetes and Myocardial Fibrosis: A Systematic Review and Meta-Analysis

JACC Cardiovasc Imaging. 2022 May;15(5):796-808. doi: 10.1016/j.jcmg.2021.12.008. Epub 2022 Feb 16.

Affiliations

¹ Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Graduate School for Health Sciences, University of Bern, Bern, Switzerland; Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Switzerland.
² Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Graduate School for Health Sciences, University of Bern, Bern, Switzerland.
³ Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Graduate School for Health Sciences, University of Bern, Bern, Switzerland; Swiss Paraplegic Research, Notwill, Switzerland.
⁴ Public Health and Primary Care Library, University Library of Bern, University of Bern, Bern, Switzerland.
⁵ Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Switzerland.
⁶ University Department of Diabetes, Endocrinology, Nutritional Medicine, and Metabolism, Inselspital, Bern University Hospital, Bern, Switzerland; Department for Biomedical Research, Faculty of Medicine, University of Bern, Bern, Switzerland.
⁷ Section on Genetics and Epidemiology, Research Division, Joslin Diabetes Center, Boston, Massachusetts, USA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.
⁸ Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
⁹ Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Switzerland. Electronic address: arjola.bano@ispm.unibe.ch.

PMID: 35512952
DOI: 10.1016/j.jcmg.2021.12.008

Abstract

Objectives: This systematic review and meta-analysis investigated the association of diabetes and glycemic control with myocardial fibrosis (MF).

Background: MF 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.

Methods: The 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).

Results: A 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.

Conclusions: Diabetes 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.

Keywords: CMR T1 mapping; diabetes; glycosylated hemoglobin; meta-analysis; myocardial extracellular matrix; myocardial fibrosis.

Publication types

Meta-Analysis
Systematic Review
Research Support, Non-U.S. Gov't

MeSH terms

Cardiomyopathies*
Diabetes Mellitus, Type 2* / complications
Diabetes Mellitus, Type 2* / diagnosis
Diabetes Mellitus, Type 2* / drug therapy
Fibrosis
Humans
Magnetic Resonance Imaging, Cine
Myocardium / pathology
Predictive Value of Tests