中年胰岛素抵抗和血糖代谢异常与左心室结构和功能的关系：CARDIA 研究。
Association of Insulin Resistance and Glycemic Metabolic Abnormalities With LV Structure and Function in Middle Age: The CARDIA Study.
机构信息
Johns Hopkins University, Baltimore, Maryland; Mitsui Memorial Hospital, Tokyo, Japan.
A.I. DuPont Hospital for Children, Wilmington, Delaware.
出版信息
JACC Cardiovasc Imaging. 2017 Feb;10(2):105-114. doi: 10.1016/j.jcmg.2016.02.033. Epub 2016 Aug 17.
OBJECTIVES
This study sought to investigate how cumulative exposure to glycemic abnormalities and trajectories of insulin resistance (IR) relate to left ventricular (LV) remodeling and function during young to middle adulthood.
BACKGROUND
Cumulative exposure to glycemic abnormalities and trajectories of IR may adversely influence LV remodeling and function over a 25-year period in subjects who were young adults, predisposing individuals to heart failure later in life.
METHODS
In the CARDIA (Coronary Artery Risk Development in Young Adults) Year 25 examination, 3,179 participants were identified with information on glucose metabolism; these participants were stratified into 4 subgroups: group 1 normal glucose tolerance (NGT), group 2 impaired glucose tolerance (IGT) or impaired fasting glucose, group 3 late diabetes mellitus (DM) (DM diagnosed at year 15 or later), and group 4 early DM (DM diagnosed at year 0 to year 15). Among the subgroup without DM, 3 trajectory groups of change in the homeostasis model assessment of IR were identified: low IR, moderate IR, and high IR. LV mass, relative wall thickness, LV ejection fraction (LVEF), longitudinal systolic strain (Ell), and early diastolic strain rate (Ell_SRe) at year 25 were assessed by echocardiography. Clinically relevant systolic and diastolic dysfunction were defined as LVEF <50% for systolic dysfunction, and E/e' ≥13 for diastolic dysfunction.
RESULTS
The early DM group had less favorable LV mass (coefficient = 11.04; p < 0.001), LVEF (coefficient = -2.72; p < 0.05), Ell (coefficient = 1.53; p < 0.001), and Ell_SRe (coefficient = -0.09; p < 0.05) than did the NGT group. Being in the early DM group and having high hemoglobin A were independently associated with greater odds of having systolic dysfunction (odds ratio = 5.44; p < 0.005) compared with the NGT group. High IR was associated with worse relative wall thickness (coefficient = 0.019; p < 0.0001) and worse Ell, E', and Ell_SRe, depending on obesity level.
CONCLUSIONS
Cumulative exposure to DM or higher IR beginning in early adulthood adversely impacts LV remodeling and function at middle age.
目的
本研究旨在探讨血糖异常的累积暴露和胰岛素抵抗（IR）轨迹与年轻至中年期间左心室（LV）重构和功能的关系。
背景
在年轻成年人中，血糖异常的累积暴露和 IR 轨迹可能在 25 年内对 LV 重构和功能产生不利影响，使个体易患心力衰竭。
方法
在 CARDIA（年轻人冠状动脉风险发展）第 25 年检查中，确定了 3179 名参与者的葡萄糖代谢信息；这些参与者被分为 4 个亚组：第 1 组为正常糖耐量（NGT），第 2 组为糖耐量受损（IGT）或空腹血糖受损，第 3 组为晚期糖尿病（DM）（15 年后诊断），第 4 组为早期 DM（0 至 15 年内诊断）。在无 DM 的亚组中，根据稳态模型评估的 IR 变化，确定了 3 个轨迹组：低 IR、中 IR 和高 IR。通过超声心动图评估 25 年时的左心室质量、相对壁厚度、左心室射血分数（LVEF）、纵向收缩应变（Ell）和舒张早期应变率（Ell_SRe）。临床上明显的收缩和舒张功能障碍定义为收缩功能障碍时的 LVEF<50%，舒张功能障碍时的 E/e'≥13。
结果
早期 DM 组的左心室质量（系数= 11.04；p<0.001）、LVEF（系数= -2.72；p<0.05）、Ell（系数= 1.53；p<0.001）和 Ell_SRe（系数= -0.09；p<0.05）均低于 NGT 组。与 NGT 组相比，早期 DM 组和高血红蛋白 A 与更大的收缩功能障碍几率独立相关（比值比= 5.44；p<0.005）。高 IR 与较高的相对壁厚度（系数= 0.019；p<0.0001）以及 Ell、E'和 Ell_SRe 恶化相关，这取决于肥胖程度。
结论
成年早期开始的 DM 或更高的 IR 累积暴露会对中年时期的 LV 重构和功能产生不利影响。
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