The relationship between abnormal myocardial alterations and glycemic control validated by cardiac magnetic resonance in a pig model of diabetes mellitus

Aims: To investigate the relationship between hemoglobin (HbAlc) and abnormal myocardial alterations as determined by cardiac magnetic resonance (CMR) T1 mapping and feature tracking in a pig model of diabetes mellitus (DM). Methods Eight DM models were successfully established and were divided into two groups based on their HbAlc median value (high HbAlc ≥ 6.07%, n = 5; low HbAlc < 6.07%, n = 3). As controls, five healthy age-matched pigs were used. Over the diabetic course of 16 months, CMR cine, T1 mapping, and late enhancement gadolinium (LGE) were performed. Afterward, three pigs were then sacrificed and stained with masson trichrome and advanced glycation end products (AGEs) from control, high, and low HbAlc groups, respectively. Results Diabetes and control groups did not differ in terms of left ventricular ejection fraction (p = 0.784) and showed no evidence of LGE. However, when compared to controls, pigs with high HbAlc had higher native T1 and ECV as well as lower longitudinal strain and strain rate (all p < 0.05). Furthermore, HbAlc correlated well with native T1, ECV, longitudinal strain, and diastolic strain rate (R 2  = 0.470 to 0.849, all p < 0.05). Histological staining showed more significant deposition of myocardial interstitial fibrosis and AGEs in the pig with high HbAlc than in the other two pigs. Conclusions High HbAlc was associated with increased myocardial native T1 and ECV and decreased longitudinal myocardial deformation in DM pigs.