{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,5]],"date-time":"2026-11-05T08:32:16Z","timestamp":1793867536139,"version":"4.6.1"},"reference-count":50,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2026,2,25]],"date-time":"2026-02-25T00:00:00Z","timestamp":1771977600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000272","name":"National Institute for Health and Care Research","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100018955","name":"Leeds Biomedical Research Centre","doi-asserted-by":"publisher","award":["NIHR203331"],"award-info":[{"award-number":["NIHR203331"]}],"id":[{"id":"10.13039\/501100018955","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100018955","name":"Leeds Biomedical Research Centre","doi-asserted-by":"publisher","award":["FS\/16\/47\/32190"],"award-info":[{"award-number":["FS\/16\/47\/32190"]}],"id":[{"id":"10.13039\/501100018955","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100018955","name":"Leeds Biomedical Research Centre","doi-asserted-by":"publisher","award":["RP-2017-08-ST2-007"],"award-info":[{"award-number":["RP-2017-08-ST2-007"]}],"id":[{"id":"10.13039\/501100018955","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000274","name":"British Heart Foundation","doi-asserted-by":"publisher","award":["17\/YH\/0300"],"award-info":[{"award-number":["17\/YH\/0300"]}],"id":[{"id":"10.13039\/501100000274","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000274","name":"British Heart Foundation","doi-asserted-by":"publisher","award":["18\/YH\/0168"],"award-info":[{"award-number":["18\/YH\/0168"]}],"id":[{"id":"10.13039\/501100000274","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000274","name":"British Heart Foundation","doi-asserted-by":"publisher","award":["18\/YH\/01900"],"award-info":[{"award-number":["18\/YH\/01900"]}],"id":[{"id":"10.13039\/501100000274","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000272","name":"National Institute for Health Research","doi-asserted-by":"publisher","award":["CH\/16\/2\/32089"],"award-info":[{"award-number":["CH\/16\/2\/32089"]}],"id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000272","name":"National Institute for Health Research","doi-asserted-by":"publisher","award":["221690\/Z\/20\/Z"],"award-info":[{"award-number":["221690\/Z\/20\/Z"]}],"id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000272","name":"National Institute for Health Research","doi-asserted-by":"publisher","award":["95\/01.09.2020"],"award-info":[{"award-number":["95\/01.09.2020"]}],"id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,4,30]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>In individuals with type 2 diabetes mellitus (T2DM), both myocardial ischemia and myocardial infarction (MI) are associated with adverse cardiovascular outcomes. The incremental prognosis of both risks is unknown. We aimed to investigate whether abnormal myocardial perfusion reserve (MPR), as a surrogate marker for ischemia and presence of MI offers incremental prognostic value in predicting major adverse cardiovascular and cerebrovascular events (MACCE) in patients with T2DM.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>A retrospective multicentre cohort of 572 individuals with T2DM and healthy controls underwent quantitative stress myocardial perfusion cardiovascular magnetic resonance (CMR) to determine MPR and late gadolinium enhancement (LGE) to identify MI. Patients were divided into three groups: MI- and normal MPR, MI+ or abnormal MPR and MI+ and abnormal MPR. Cox proportional hazard models quantified associations between MPR and MI with MACCE (composite of all-cause death, MI, stroke, heart failure hospitalization, and late coronary revascularization&amp;gt;90 days after the CMR scan). Over a median of 28 months (IQR 25\u201331 months), 81 participants (14%) accrued at least one MACCE, including 25 (4%) deaths. Presence of either abnormal MPR or MI was associated with increased MACCE (MI- and normal MPR: 8% MACCE; MI+ or abnormal MPR: 15% MACCE (adjusted HR compared with normal 1.86 (95% CI 1.06\u20133.25, P = 0.03)); presence of both MI and abnormal MPR had the highest event rate: 30% MACCE (adjusted HR compared with normal 3.24 (95% CI 1.75\u20136.01, P &amp;lt; 0.001)).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In T2DM, abnormal MPR or MI are associated with MACCE, and the presence of both offers incremental prognostic value.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ehjci\/jeag047","type":"journal-article","created":{"date-parts":[[2026,2,21]],"date-time":"2026-02-21T12:36:07Z","timestamp":1771677367000},"page":"984-995","source":"Crossref","is-referenced-by-count":5,"title":["Abnormal myocardial perfusion reserve and myocardial infarction determine cardiovascular outcomes in type 2 diabetes mellitus"],"prefix":"10.1093","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5880-1722","authenticated-orcid":false,"given":"Noor","family":"Sharrack","sequence":"first","affiliation":[{"name":"Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds , Leeds LS2 9NL ,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1611-817X","authenticated-orcid":false,"given":"Kristopher D","family":"Knott","sequence":"additional","affiliation":[{"name":"Barts Heart Centre, St Bartholomew\u2019s Hospital , London ,","place":["United Kingdom"]},{"name":"Institute of Cardiovascular Science, University College London , London ,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jian L","family":"Yeo","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Biomedical Research Centre, Glenfield Hospital , Leicester ,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0059-4817","authenticated-orcid":false,"given":"Tushar","family":"Kotecha","sequence":"additional","affiliation":[{"name":"Institute of Cardiovascular Science, University College London , London ,","place":["United Kingdom"]},{"name":"Division of Medicine, National Amyloidosis Centre, University College London , Royal Free Campus, London ,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Louise A E","family":"Brown","sequence":"additional","affiliation":[{"name":"Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds , Leeds LS2 9NL ,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aldostefano","family":"Porcari","sequence":"additional","affiliation":[{"name":"Division of Medicine, National Amyloidosis Centre, University College London , Royal Free Campus, London ,","place":["United Kingdom"]},{"name":"Cardiovascular Department, Centre for Diagnosis and Treatment of Cardiomyopathies, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), University of Trieste , Trieste ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert D","family":"Adam","sequence":"additional","affiliation":[{"name":"Barts Heart Centre, St Bartholomew\u2019s Hospital , London ,","place":["United Kingdom"]},{"name":"Institute of Cardiovascular Science, University College London , London ,","place":["United Kingdom"]},{"name":"Institute of Cardiovascular Diseases, Carol Davila University of Medicine and Pharmacy , Bucharest ,","place":["Romania"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gaurav S","family":"Gulsin","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Biomedical Research Centre, Glenfield Hospital , Leicester ,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sharmaine","family":"Thirunavukarasu","sequence":"additional","affiliation":[{"name":"Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds , Leeds LS2 9NL ,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amrit","family":"Chowdhary","sequence":"additional","affiliation":[{"name":"Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds , Leeds LS2 9NL ,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masafumi","family":"Takafuji","sequence":"additional","affiliation":[{"name":"Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds , Leeds LS2 9NL ,","place":["United Kingdom"]},{"name":"Department of Radiology and Mie University Hospital , Tsu, Mie ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eylem","family":"Levelt","sequence":"additional","affiliation":[{"name":"Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds , Leeds LS2 9NL ,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2861-0914","authenticated-orcid":false,"given":"John P","family":"Greenwood","sequence":"additional","affiliation":[{"name":"Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds , Leeds LS2 9NL ,","place":["United Kingdom"]},{"name":"Department of Cardiology, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust , Great George Street, Leeds LS1 3EX ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David L","family":"Buckley","sequence":"additional","affiliation":[{"name":"Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds , Leeds LS2 9NL ,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1307-6691","authenticated-orcid":false,"given":"Theresa","family":"Munyombwe","sequence":"additional","affiliation":[{"name":"Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds , Leeds LS2 9NL ,","place":["United Kingdom"]},{"name":"Leeds Institute for Data Analytics, University of Leeds , Leeds ,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chris P","family":"Gale","sequence":"additional","affiliation":[{"name":"Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds , Leeds LS2 9NL ,","place":["United Kingdom"]},{"name":"Department of Cardiology, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust , Great George Street, Leeds LS1 3EX ,","place":["UK"]},{"name":"Leeds Institute for Data Analytics, University of Leeds , Leeds ,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9875-6070","authenticated-orcid":false,"given":"Peter","family":"Kellman","sequence":"additional","affiliation":[{"name":"Department of Health and Human Services, National Heart, Lung, and Blood Institute, National Institutes of Health , Bethesda, MD ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James C","family":"Moon","sequence":"additional","affiliation":[{"name":"Barts Heart Centre, St Bartholomew\u2019s Hospital , London ,","place":["United Kingdom"]},{"name":"Institute of Cardiovascular Science, University College London , London ,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marianna","family":"Fontana","sequence":"additional","affiliation":[{"name":"Institute of Cardiovascular Science, University College London , London ,","place":["United Kingdom"]},{"name":"Division of Medicine, National 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