ORIGINAL RESEARCH article
Front. Endocrinol.
Sec. Cardiovascular Endocrinology
Volume 16 - 2025 | doi: 10.3389/fendo.2025.1653927
This article is part of the Research TopicThe Complex Phenotype of Diabetic Cardiomyopathy: Clinical Indicators and Novel Treatment Targets – Volume IIView all 7 articles
Impact of Glucose Metabolism on Myocardial Fibrosis and Inflammation in Hypertrophic Cardiomyopathy: A Cardiac MR Study
Provisionally accepted
Xin Peng1
Huaibi Huo2Zhengkai Zhao1Qiuyi Cai1Jiangyu Tian1Dandan Yang1Yao Song3Yuheng Huang4Zhuoan Li5
Jin Gao1*- 1Chengdu Third People's Hospital, Chengdu, China
- 2The First Hospital of China Medical University, Shenyang, China
- 3Liaoning University of Traditional Chinese Medicine Affiliated Hospital, Shenyang, China
- 4Indiana University School of Medicine, Indianapolis, United States
- 5Purdue University Weldon School of Biomedical Engineering, West Lafayette, United States
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Diabetes mellitus increases the risk of adverse cardiovascular outcomes in hypertrophic cardiomyopathy (HCM) patients. This retrospective study aimed to evaluate myocardial microstructural alterations, particularly fibrosis and subclinical inflammation, in HCM patients across glycemic statuses using multiparametric cardiac magnetic resonance (CMR). Additionally, it explored the correlation between myocardial fibrosis and hemoglobin A1c (HbA1c) levels. 108 HCM patients were stratified by HbA1c levels into non-diabetic (n=38), prediabetic (n=40), and diabetic (n=30) subgroups, along with 30 healthy controls. All participants underwent 3.0-T CMR examination. Compared to non-diabetic HCM patients, prediabetic and diabetic HCM patients exhibited progressively higher mean T1 values and extracellular volume fractions (ECV) (p < 0.001). Similar trends were observed in hypertrophic myocardial regions, with diabetes patients showing pronounced fibrosis. Mean ECV exhibited a strong positive correlation with HbA1c levels (r = 0.634, p < 0.001). In the fully adjusted model, both T1 values and ECV demonstrated significant associations with HbA1c levels. Subclinical myocardial inflammation, as evidenced by elevated T1 and T2 values, was observed in prediabetic and diabetic patients but not in non-diabetic patients. Progression of myocardial fibrosis in HCM is linked to elevated HbA1c, especially in hypertrophied regions, even in prediabetic individuals. Subclinical myocardial inflammation was observed in HCM with glucose metabolism abnormalities. These findings underscore the importance of early glycemic control and the integration of CMR-based tissue characterization into HCM management strategies.
Keywords: Hypertrophic Cardiomyopathy, HbA1c, cardiac magnetic resonance, Myocardial fibrosis, Subclinical myocardial inflammation
Received: 25 Jun 2025; Accepted: 01 Aug 2025.
Copyright: © 2025 Peng, Huo, Zhao, Cai, Tian, Yang, Song, Huang, Li and Gao. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Jin Gao, Chengdu Third People's Hospital, Chengdu, China
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