The first part of this thesis focuses on assessing end-organ damage in individuals with the metabolic syndrome and diabetes mellitus using magnetic resonance imaging (MRI) and spectroscopy (1H-MRS)... Show moreThe first part of this thesis focuses on assessing end-organ damage in individuals with the metabolic syndrome and diabetes mellitus using magnetic resonance imaging (MRI) and spectroscopy (1H-MRS). We performed cross sectional and intervention studies to investigate the contribution of obesity, dietary conditions, metabolic environment and exogenous disruptors (chemotherapy) to cardiovascular end-organ damage and the reversibility of this damage with a low caloric diet. The effects of interventions, dietary as well as non-dietary, were explored using imaging technology. As ethnicity is an important aspect of the pathophysiology in diabetes mellitus, we also examined the influence of ethnic factors on diabetes mellitus and its complications. The second part of this thesis focuses on safety, feasibility and implementation of innovative MR techniques at higher field strengths for assessment of cardiovascular disease. Show less
Cardiovascular risk assessment in patients with diabetes mellitus (DM) remains challenging. Risk scores to predict cardiovascular risk are widely used, but are developed in the general population... Show moreCardiovascular risk assessment in patients with diabetes mellitus (DM) remains challenging. Risk scores to predict cardiovascular risk are widely used, but are developed in the general population and tend to underestimate the cardiovascular risk of DM patients. Risk scores developed in diabetic populations to estimate cardiovascular risk have demonstrated good calibration and discriminations indices. However, external validation is still needed. A recent meta-analysis showed that the predictive ability of these scores developed in diabetic populations is not superior to those scores developed in general population. Accordingly, the additional use of other biomarkers or imaging tools seems a good alternative to better risk stratify diabetic patients. This thesis evaluates the application and performance of non-invasive cardiac imaging tests for cardiovascular risk assessment and management of DM patients. Identification of new markers of CAD derived from non-invasive cardiac imaging might result in a broader applicability of cardiovascular risk assessment. Non-invasive cardiac imaging tests might evaluate target organ damage as well as the presence, severity and extent of subclinical atherosclerosis preceding overt clinical CAD. Thus, high-risk patients for CAD can be identified and further decision making of each DM patient can be tailored in order to improve the clinical outcomes at long-term follow-up Show less
