Pareek Manan, Vaduganathan Muthiah, Bhatt Deepak L, Leósdóttir Margrét, Olsen Michael H
Cardiovascular and Metabolic Preventive Clinic, Department of Endocrinology, Centre for Individualized Medicine in Arterial Diseases (CIMA), Sdr. Boulevard 29, Odense University Hospital, 5000 Odense C, Denmark; Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, 75 Francis St, Boston, MA 02115, USA.
Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, 75 Francis St, Boston, MA 02115, USA.
Int J Cardiol. 2017 Aug 15;241:423-429. doi: 10.1016/j.ijcard.2017.01.133. Epub 2017 Feb 7.
To examine whether baseline fasting plasma glucose (FPG) modifies the prognostic role of left ventricular (LV) mass, geometric pattern, and diastolic function, for prediction of cardiovascular morbidity and mortality.
Population-based cohort study comprising of 1047 men and 456 women with preserved ejection fraction, included between 2002 and 2006, who underwent echocardiography based on groups defined by FPG, measured prior to echocardiography. The clinical endpoint was the composite of cardiovascular events and all-cause mortality, assessed through national and local registries. Cox proportional-hazards regression with interaction analysis was used to evaluate the risk associated with FPG and LV structure and function.
Median age was 67years, and 31% had impaired fasting glucose, 31% diabetes, 17% LV hypertrophy, and 40% diastolic dysfunction. During a median follow-up duration of 8.3years, 449 composite events occurred. FPG (hazard ratio (HR), 1.09 (95% confidence interval (CI): 1.05-1.13), P<0.001) and several markers of LV structure and function, including LV mass index (HR, 1.10 (95% CI: 1.06-1.15), P<0.001) and E/é (HR, 1.08 (95% CI 1.05-1.10), P<0.001) were associated with an increased risk of events. In the subgroup of 678 individuals without previous cardiovascular disease, who did not receive cardiovascular, anti-diabetic, or lipid-lowering medication, FPG significantly interacted with the association between concentric LV hypertrophy and event risk (P<0.001), and with the association between diastolic dysfunction and event risk (P=0.02), including grade 2 or 3 dysfunction (P=0.04).
Echocardiographic abnormalities were more strongly associated with an adverse prognosis among subjects with impaired fasting glucose or diabetes.
研究空腹血糖（FPG）基线水平是否会改变左心室（LV）质量、几何形态和舒张功能对心血管疾病发病率和死亡率预测的预后作用。
基于人群的队列研究，纳入了2002年至2006年间1047名男性和456名女性射血分数保留者，根据超声心动图检查前测量的FPG分组进行超声心动图检查。临床终点为心血管事件和全因死亡率的综合指标，通过国家和地方登记处进行评估。采用带有交互分析的Cox比例风险回归来评估FPG与LV结构和功能相关的风险。
中位年龄为67岁，31%有空腹血糖受损，31%患有糖尿病，17%有LV肥厚，40%有舒张功能障碍。在中位随访期8.3年期间，发生了449例综合事件。FPG（风险比（HR），1.09（95%置信区间（CI）：1.05 - 1.13），P<0.001）以及LV结构和功能的几个指标，包括LV质量指数（HR，1.10（95%CI：1.06 - 1.15），P<0.001）和E/é（HR，1.08（95%CI 1.05 - 1.10），P<0.001）与事件风险增加相关。在678名无既往心血管疾病且未接受心血管、抗糖尿病或降脂药物治疗的个体亚组中，FPG与同心性LV肥厚和事件风险之间的关联（P<0.001）以及与舒张功能障碍和事件风险之间的关联（P = 0.02）存在显著交互作用，包括2级或3级功能障碍（P = 0.04）。
空腹血糖受损或糖尿病患者中，超声心动图异常与不良预后的关联更强。
