IRMcardiaque et index de fibrose dans la cardiomyopathie diabétique

Date de début de l'étude : 1 août 2013

For PHASE I (Prospective Cohort Study to determine prognostic value of fibrotic index) Inclusion Criteria: Diabetes mellitus, type II Age >= 40 years UKPDS 10 year Risk Score > 15% Low risk stress test (defined explicitily in our protocol) Exclusion Criteria: suspected or confirmed myocarditis or infiltrative disease (including hemochromatosis, sarcoid, or amyloid) history of prior MI or coronary revascularization (by Q waves on electrocardiogram in 2 contiguous leads or by clinical history) clinical HF (with prior hospital admission for HF or documentation of reduced LV ejection fraction after index CMR) metallic hazards hematocrit < 30% (within 1 year of nuclear stress test) or history of active bleeding (within 3 months of stress test) estimated GFR (by Modified Diet in Renal Disease) < 45 ml/min/1.73m2 (within 2 weeks of planned CMR) pregnancy severe non-cardiac illness that or prognosis (e.g., end stage liver disease, malignancy, advanced HIV/AIDS) For PHASE 2: Inclusion Criteria: Included in Phase I Systolic blood pressure > 140 mmHg on two occasions (at the initial nuclear stress test and at the index cardiac MRI) Exclusion criteria: Concomitant cytochrome P450 (CYP3A4) inhibitors or inducers; Concomitant potassium supplementation or potassium sparing diuretics; Concomitant use of both ACE inhibitor and ARB therapy (at any dose); Renal dysfunction (GFR < 50 ml/min or serum creatinine > 1.5 mg/dL (as assessed at time of index CMR); Any urine microalbuminuria (as assessed at time of index CMR); Baseline (pre-therapy) serum potassium > 5.0 mEq/L; Lack of reliable telephone contact number for relaying results or the need to discontinue drug therapy; Age > 75 years (given the tendency toward renal insufficiency not captured by GFR, dehydration and/or concomitant illness) Women able to become pregnant (given the undefined risk of eplerenone therapy in pregnant women and newborns).