Aortic stiffness is associated with white matter integrity in patients with type 1 diabetes
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To assess the association between aortic pulse wave velocity (PWV) as a marker of arterial stiffness and diffusion tensor imaging of brain white matter integrity in patients with type 1 diabetes using advanced magnetic resonance imaging (MRI) technology.
Forty-one patients with type 1 diabetes (23 men, mean age 44 ± 12 years, mean diabetes duration 24 ± 13 years) were included. Aortic PWV was assessed using through-plane velocity-encoded MRI. Brain diffusion tensor imaging (DTI) measurements were performed on 3-T MRI. Fractional anisotropy (FA) and apparent diffusion coefficient (ADC) were calculated for white and grey matter integrity. Pearson correlation and multivariable linear regression analyses including cardiovascular risk factors as covariates were assessed.
Multivariable linear regression analyses revealed that aortic PWV is independently associated with white matter integrity FA (β = −0.777, p = 0.008) in patients with type 1 diabetes. This effect was independent of age, gender, mean arterial pressure, body mass index, smoking, duration of diabetes and glycated haemoglobin levels. Aortic PWV was not significantly related to grey matter integrity.
Our data suggest that aortic stiffness is independently associated with reduced white matter integrity in patients with type 1 diabetes.
• Aortic stiffness is associated with brain injury.
• Aortic stiffness exposes small vessels to high pressure fluctuations and flow.
• Aortic stiffness is associated with microvascular brain injury in diabetes.
• This suggests a vascular contribution to early subtle microstructural deficits.
KeywordsAorta Magnetic resonance imaging Type 1 diabetes mellitus Brain Aniosotropy
The scientific guarantor of this publication is Professor A. De Roos. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. This study has received funding by the Center for Translational Molecular Medicine (CTMM; www.ctmm.nl), project PREDICCt (grant 01C-104) and supported by the The Netherlands Heart Foundation (Project UL 2009-4548), Dutch Diabetes Research Foundations and Dutch Kidney Foundation. The funding sources had no involvement in the study design, the collection, analysis and interpretation of data, in the writing of the report and in the decision to submit the paper for publication. No complex statistical methods were necessary for this paper. Institutional review board approval was obtained. Written informed consent was obtained from all subjects (patients) in this study. Some study subjects or cohorts have been previously reported in Diabetes Care 34:459-463, 2011 (van Elderen SG, Brandts A, van der Grond J, et al., Cerebral perfusion and aortic stiffness are independent predictors of white matter brain atrophy in type 1 diabetic patients assesses with magnetic resonance imaging).
Methodology: cross-sectional study, performed at one institution.