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Phenotypic Multiorgan Involvement of Subclinical Disease as Quantified by Magnetic Resonance Imaging in Subjects With Prediabetes, Diabetes, and Normal Glucose Tolerance

Storz, Corinna, MD*; Rospleszcz, Susanne, MSc; Lorbeer, Roberto, PhD‡§; Hetterich, Holger, MD‡§; Auweter, Sigrid, D., PhD; Sommer, Wieland, MD; Machann, Jürgen, PhD*∥¶#; Gatidis, Sergios, MD*; Rathmann, Wolfgang, MD**; Heier, Margit, MD; Linkohr, Birgit, PhD; Meisinger, Christa, MD, MPH†††; Reiser, Maximilian, MD; Hoffmann, Udo, MD, MPH‡‡; Peters, Annette, PhD†§§§; Schlett, Christopher, L., MD, MPH∥∥; Bamberg, Fabian, MD, MPH*‡§

doi: 10.1097/RLI.0000000000000451
Original Articles

Introduction Detailed mechanisms in the pathophysiology of diabetes disease are poorly understood, but structural alterations in various organ systems incur an elevated risk for cardiovascular events and adverse outcome. The aim of this study was to compare multiorgan subclinical disease phenotypes by magnetic resonance (MR) imaging to study differences between subjects with prediabetes, diabetes, and normal controls.

Materials and Methods Subjects without prior cardiovascular disease were enrolled in a prospective case-control study and underwent multiorgan MR for the assessment of metabolic and arteriosclerotic alterations, including age-related white matter changes, hepatic proton density fat fraction, visceral adipose tissue volume, left ventricular remodeling index, carotid plaque, and late gadolinium enhancement. Magnetic resonance features were summarized in a phenotypic-based score (range, 0–6). Univariate, multivariate correlation, and unsupervised clustering were performed.

Results Among 243 subjects with complete multiorgan MR data sets included in the analysis (55.6 ± 8.9 years, 62% males), 48 were classified as subjects with prediabetes and 38 as subjects with diabetes. The MR phenotypic score was significantly higher in subjects with prediabetes and diabetes as compared with controls (mean score, 3.00 ± 1.04 and 2.69 ± 0.98 vs 1.22 ± 0.98, P < 0.001 respectively), also after adjustment for potential confounders. We identified 2 clusters of MR phenotype patterns associated with glycemic status (P < 0.001), independent of the MR score (cluster II–metabolic specific: odds ratio, 2.49; 95% CI, 1.00–6.17; P = 0.049).

Discussion Subjects with prediabetes and diabetes have a significantly higher phenotypic-based score with a distinctive multiorgan phenotypic pattern, which may enable improved disease characterization.

From the *Department of Diagnostic and Interventional Radiology University of Tuebingen, Tuebingen; †Institute of Epidemiology II, Helmholtz Zentrum Muenchen, German Research Center for Environmental Health, Neuherberg; ‡Department of Radiology, Ludwig-Maximilians-University-Hospital; §German Center for Cardiovascular Disease Research (DZHK e.V.), Munich; ∥Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Centre Munich at the University of Tuebingen; ¶German Centre for Diabetes Research (DZD); #Section on Experimental Radiology, Department of Diagnostic and Interventional Radiology, University Hospital Tuebingen, Tuebingen; **Department of Biometry and Epidemiology, German Diabetes Center, Duesseldorf; ††KORA Myocardial Infarction Registry, Central Hospital of Augsburg, Augsburg, Germany; ‡‡Cardiac MR PET CT Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA; §§Institute for Cardiovascular Prevention, Ludwig-Maximilians-University-Hospital, Munich; and ∥∥Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany.

Received for publication November 7, 2017; and accepted for publication, after revision, December 30, 2017.

Conflicts of interest and sources of funding: This study was funded by the German Research Foundation (DFG, Bonn, Germany), the German Centre for Cardiovascular Disease Research (DZHK, Berlin, Germany), and the German Centre for Diabetes Research (DZD e.V., Neuherberg, Germany).

The KORA study was initiated and financed by the Helmholtz Zentrum München–German Research Center for Environmental Health, which is funded by the German Federal Ministry of Education and Research (BMBF) and by the State of Bavaria.

The authors report no conflicts of interest.

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Correspondence to: Fabian Bamberg, MD, MPH, Department of Diagnostic and Interventional Radiology, University of Tuebingen, Hoppe-Seyler-Straße 3, 72076 Tuebingen, Germany. E-mail:

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