Holland David J, Marwick Thomas H, Haluska Brian A, Leano Rodel, Hordern Matthew D, Hare James L, Fang Zhi You, Prins Johannes B, Stanton Tony
School of Medicine, The University of Queensland, Brisbane, Queensland, Australia School of Medicine, The University of Notre Dame Australia, Sydney, New South Wales, Australia School of Human Movement Studies, The University of Queensland, Brisbane, Queensland, Australia.
Menzies Research Institute Tasmania, Hobart, Tasmania, Australia.
Heart. 2015 Jul;101(13):1061-6. doi: 10.1136/heartjnl-2014-307391. Epub 2015 May 2.
New imaging techniques have permitted the detection of subclinical LV dysfunction (LVD) in up to half of patients with type 2 diabetes mellitus (DM) with a normal EF. However, the connection between early LVD and prognosis is unclear. This study aimed to define the long-term outcome of LVD associated with type 2 DM.
In this prospective cohort study, 230 asymptomatic patients with type 2 DM underwent measurement of global longitudinal 2D strain (GLS) for detection of LVD and were followed for up to 10 years. All subjects had normal EF (≥50%) and no evidence of coronary artery disease at recruitment. Outcome data were obtained through centralised state-wide death and hospital admission registries. The primary endpoint was all-cause mortality and hospitalisation.
On study entry, almost half (45%) of the cohort had evidence of LVD as detected by GLS. Over a median follow-up of 7.4±2.6 years (range 0.6-9.7 years), 68 patients (30%) met the primary endpoint (LVD: 37%; normal LV function: 24%). GLS was independently associated with the primary endpoint (HR=1.10; p=0.04), as was systolic blood pressure (HR=1.02; p<0.001) and levels of glycosylated haemoglobin (HR=1.28; p=0.011). Patients with LVD had significantly worse outcome than those without (χ(2)=4.73; p=0.030).
Subclinical LVD is common in asymptomatic patients with type 2 DM, is readily detectable by GLS imaging and is independently associated with adverse outcome.
Australian and New Zealand Clinical Trials Registry (ACTRN12612001178831).
新的成像技术已能够在高达半数射血分数（EF）正常的2型糖尿病（DM）患者中检测到亚临床左心室功能障碍（LVD）。然而，早期LVD与预后之间的联系尚不清楚。本研究旨在明确与2型DM相关的LVD的长期预后。
在这项前瞻性队列研究中，230例无症状的2型DM患者接受了整体纵向二维应变（GLS）测量以检测LVD，并随访长达10年。所有受试者在入组时EF均正常（≥50%）且无冠状动脉疾病证据。结局数据通过全州范围内的集中死亡和住院登记处获取。主要终点为全因死亡率和住院率。
在研究开始时，近半数（45%）的队列患者经GLS检测有LVD证据。在中位随访7.4±2.6年（范围0.6 - 9.7年）期间，68例患者（30%）达到主要终点（LVD组：37%；左心室功能正常组：24%）。GLS与主要终点独立相关（HR = 1.10；p = 0.04），收缩压（HR = 1.02；p < 0.001）和糖化血红蛋白水平（HR = 1.28；p = 0.011）也是如此。有LVD的患者结局明显比无LVD的患者差（χ(2)=4.73；p = 0.030）。
亚临床LVD在无症状的2型DM患者中很常见，可通过GLS成像轻易检测到，且与不良结局独立相关。
澳大利亚和新西兰临床试验注册中心（ACTRN12612001178831）
