High-Resolution Cardiac MRI and Serum Biomarker Correlation in Early Detection of Myocardial Fibrosis Among Asymptomatic Type 2 Diabetic Patients

Abstract

Background: Myocardial fibrosis (MF) is an early indicator of cardiovascular complications in type 2 diabetes mellitus (T2DM), often going undetected due to its asymptomatic nature in the early stages. Objective: To assess the correlation between high-resolution cardiac magnetic resonance imaging (CMR) and serum biomarkers in the early detection of myocardial fibrosis in asymptomatic T2DM patients. Methods: A total of 148 asymptomatic T2DM patients (mean age 58.2 ± 8.5 years) were enrolled at the National Heart Centre Singapore from January 2021 to June 2022. Each participant underwent high-resolution CMR imaging to assess myocardial fibrosis using T1 mapping and late gadolinium enhancement (LGE). Simultaneously, serum biomarkers such as MMP-2, MMP-9, and galectin-3 were measured. Statistical analysis was performed using Pearson’s correlation coefficient, paired t-test, and linear regression. Results: CMR imaging revealed myocardial fibrosis in 42% (62/148) of patients. Serum biomarker analysis showed significant elevations in MMP-2 (p < 0.05), MMP-9 (p = 0.01), and galectin-3 (p = 0.02) in patients with fibrosis. The correlation between CMR and biomarkers was highly significant (r = 0.72, p < 0.001). Standard deviations for MMP-2, MMP-9, and galectin-3 were 1.23, 0.98, and 0.87, respectively. The overall sensitivity of serum biomarkers in detecting myocardial fibrosis was 83%, with a specificity of 77%. Conclusion: High-resolution CMR combined with serum biomarkers offers a promising non-invasive strategy for the early detection of myocardial fibrosis in asymptomatic T2DM patients.