Stress cardiovascular magnetic resonance (CMR) to screen for silent myocardial ischaemia in asymptomatic high risk patients with type 2 diabetes mellitus (DM) has never been performed, and its effectiveness is unknown. Our aim was to determine the feasibility of a screening programme using stress CMR by obtaining preliminary data on the prevalence of silent ischaemia caused by obstructive coronary artery disease (CAD) and quantify myocardial perfusion in asymptomatic high risk patients with type 2 diabetes. In this prospective cohort study, we recruited 63 asymptomatic DM patients (mean age 66 years ± 4.4 years; 77.8% male); with Framingham risk score ≥ 20% from 3 sites from June 2017 to August 2018. Normal volunteers were recruited to determine normal global myocardial perfusion reserve index (MPRI). Adenosine stress CMR and global MPRI was performed and measured in all subjects. Positive stress CMR cases were referred for catheter coronary angiography (CCA) with/without fractional flow reserve (FFR) measurements. Positive CCA was defined as an FFR ≤ 0.8 or coronary narrowing ≥ 70%. Patients were followed up for major adverse cardiovascular events. Prevalence is presented as patient numbers and percentage. Mann–Whitney U test was used to compare global MPRI between patients and normal volunteers. 13 patients had positive stress CMR with positive CCA (20.6% of patient population), while 9 patients with positive stress CMR examinations had a negative CCA. 5 patients (7.9%) had infarcts detected of which 2 patients had no stress perfusion defects. 12 patients had coronary artery stents inserted, whilst 1 patient declined stent placement. DM patients had lower global MPRI than normal volunteers (n = 7) (1.43 ± 0.27 vs 1.83 ± 0.31 respectively; p < 0.01). After a median follow-up of 653 days, there was no death, heart failure, acute coronary syndrome hospitalisation or stroke. 20.6% of asymptomatic DM patients (with Framingham risk ≥ 20%) had silent obstructive CAD. Furthermore, asymptomatic patients have reduced global MPRI than normal volunteers. Trial Registration: ClinicalTrials.gov Registration Number: NCT03263728 on 28th August 2017; https://clinicaltrials.gov/ct2/show/NCT03263728.

中文翻译：

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无症状2型糖尿病和心血管高危患者（CATCH）的心脏磁共振：一项前瞻性研究。

从未进行过压力心血管磁共振（CMR）筛查无症状的2型糖尿病（DM）高危患者的无症状心肌缺血的方法，其有效性尚不清楚。我们的目的是通过获取由阻塞性冠状动脉疾病（CAD）引起的无症状缺血的患病率的初步数据并量化无症状高危2型糖尿病患者的心肌灌注来确定使用压力CMR筛查程序的可行性。在这项前瞻性队列研究中，我们招募了63名无症状DM患者（平均年龄66岁±4.4岁；男性77.8％）；于2017年6月至2018年8月在3个地点进行Framingham风险评分≥20％。招募了正常志愿者来确定正常的全球心肌灌注储备指数（MPRI）。在所有受试者中进行并测量腺苷应激CMR和总体MPRI。将正应力CMR病例转诊至导管冠状动脉造影（CCA），进行/不进行分流储备（FFR）测量。CCA阳性定义为FFR≤0.8或冠状动脉狭窄≥70％。对患者进行重大心血管不良事件的随访。患病率以患者人数和百分比表示。使用Mann–Whitney U检验比较患者和正常志愿者之间的总体MPRI。压力CMR阳性的患者13例，CCA阳性（占总人口的20.6％），压力CMR检查阳性的9例患者的CCA阴性。检测出5例（7.9％）梗死，其中2例无压力灌注缺陷。12例患者插入了冠状动脉支架，而1例患者拒绝放置支架。DM患者的总体MPRI低于正常志愿者（n = 7）（分别为1.43±0.27和1.83±0.31； p <0.01）。中位随访653天后，没有死亡，心力衰竭，急性冠脉综合征住院或中风。无症状DM患者（弗雷明汉风险≥20％）中有20.6％患有沉默性阻塞性CAD。此外，无症状患者的总体MPRI较正常志愿者有所降低。试验注册：ClinicalTrials.gov注册编号：NCT03263728（2017年8月28日）; https://clinicaltrials.gov/ct2/show/NCT03263728。6％的无症状DM患者（Framingham风险≥20％）患有沉默性阻塞性CAD。此外，无症状患者的总体MPRI较正常志愿者有所降低。试验注册：ClinicalTrials.gov注册号：NCT03263728（2017年8月28日）; https://clinicaltrials.gov/ct2/show/NCT03263728。6％的无症状DM患者（Framingham风险≥20％）患有沉默性阻塞性CAD。此外，无症状患者的总体MPRI较正常志愿者有所降低。试验注册：ClinicalTrials.gov注册号：NCT03263728（2017年8月28日）; https://clinicaltrials.gov/ct2/show/NCT03263728。