Introduction and Objective: Diabetic retinopathy (DR) is associated with high cardiometabolic risk and early multisystem disease. We aim to see if holistic assessment of patients with DR can identify treatable disease. Using multi-organ imaging, we evaluated the prevalence of disease (pancreas, liver, heart, kidney) in individuals with DR, and no known prior cardiovascular disease.Methods: We recruited 101 individuals with DR from Moorfields Eye Hospital, London. DR was graded and multiple organ impairment was characterized by multiparametric quantitative MRI (pancreas, liver, heart, kidneys, and body composition, CoverScan™) and blood tests. Multi-organ MRI data were compared with matched non-diabetic controls (n=303), and matched people with diabetes (n=303) from UK Biobank.Results: In people with DR (mean age 63 years, 43% with DR for ≥5 years, 68% hypertensive), 95% had disease in ≥1 organ: pancreas (69%), heart (67%), liver (46%) and kidneys (9%). In 23% of people, there was impairment in ≥3 organs. 38 people had MASLD, including 15 with steatohepatitis (MASH). Liver enzymes (AST and ALT) were ‘normal’ in 37 out of 38 people with clinically significant liver disease on MRI. 30 people had impaired longitudinal strain, suggesting HFpEF; 8 people had heart failure with mildly reduced ejection fraction (HFmrEF), and 1 had heart failure with reduced ejection fraction (HFrEF). Despite the high prevalence of treatable heart disease, N-terminal pro B-type natriuretic peptide (NT-pro-BNP) was ‘normal’ in 64 out of 67 people with heart disease on gold-standard cardiac MR.Conclusion: Multi-organ MRI demonstrates significant disease in individuals with DR, much of which is missed with current standard of care blood tests. Patients with DR should be evaluated for cardiovascular disease and modifiable CV risk, especially with new therapeutic options which are proven to be cardioprotective. This approach could support holistic, integrated care where MASH and heart failure are detected and treated together.
C. Diamond: Employee; Perspectum Ltd. D. McNish-Millar: None. S. Bull: None. S. Ali: None. A. Borlotti: Employee; Perspectum Ltd. T. Kailayanathan: Employee; Perspectum Ltd. M. Mahmod: Employee; Boehringer-Ingelheim. M. Wamil: None. M. Pansini: None. R. Pattanshetty: Employee; Perspectum Ltd. A. Banerjee: None. H.B. Thomaides-Brears: Employee; Perspectum Ltd. Stock/Shareholder; Perspectum Ltd. R. Banerjee: Stock/Shareholder; Perspectum Ltd. Employee; Perspectum Ltd. I.Y.L. Yeung: None. R.D. Hamilton: Speaker’s Bureau; AbbVie Inc, Bayer Pharmaceuticals, Inc. Advisory Panel; Roche Pharmaceuticals, AbbVie Inc, Bayer Pharmaceuticals, Inc. Speaker’s Bureau; Roche Pharmaceuticals. Research Support; Roche Pharmaceuticals. Consultant; Roche Pharmaceuticals. Advisory Panel; Biogen, Nordic Bioscience A/S.
UK Biobank was accessed under application (9914)
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