Physiology Department, DHU Ageing-Thorax-Vessel-Blood, Henri Mondor Hospital, Assistance Publique Hôpitaux de Paris, Créteil, France; INSERM U955, Team08, Université Paris-Est Créteil (UPEC), Créteil, France.
Biostatistics Department, Henri Mondor Hospital, Assistance Publique Hôpitaux de Paris, Créteil, France; CEpiA EA7376, DHU Ageing-Thorax-Vessel-Blood, Université Paris Est (UPEC), Créteil, France.
J Am Coll Cardiol. 2017 Oct 3;70(14):1704-1716. doi: 10.1016/j.jacc.2017.07.792.
Type 2 diabetes mellitus (T2DM) may alter cardiac structure and function, but obesity, hypertension (HTN), or aging can induce similar abnormalities.
This study sought to link cardiac phenotypes in T2DM patients with clinical profiles and outcomes using cluster analysis.
Baseline echocardiography and a composite endpoint (cardiovascular mortality and hospitalization) were evaluated in 842 T2DM patients from 2 prospective cohorts. A cluster analysis was performed on echocardiographic variables, and the association between clusters and clinical profiles and outcomes was assessed.
Three clusters were identified. Cluster 1 patients had the lowest left ventricular (LV) mass index and ratio between early mitral inflow velocity and mitral annular early diastolic velocity (E/e') ratio, had the highest left ventricular ejection fraction (LVEF), and were predominantly male with the lowest rate of obesity or HTN. Cluster 2 patients had the highest strain and highest E/e' ratio, were the oldest, were predominantly female, and had the lowest rate of isolated T2DM (without HTN or obesity). Cluster 3 patients had the highest LV mass index and volumes and the lowest LVEF and strain, were predominantly male, and shared similar age and rate of obesity and HTN as cluster 1 patients. After follow-up of 67 months (interquartile range: 40 to 87), the composite endpoint occurred in 56 of 521 patients (10.8%). Clusters 2 (hazard ratio: 2.37; 95% confidence interval: 1.15 to 4.88) and 3 (hazard ratio: 2.19; 95% confidence interval: 1.00 to 4.82) had a similar outcome, which was worse than cluster 1.
Cluster analysis of echocardiographic variables identified 3 different echocardiographic phenotypes of T2DM patients that were associated with distinct clinical profiles and highlighted the prognostic value of LV remodeling and subclinical dysfunction.
2 型糖尿病（T2DM）可能改变心脏结构和功能，但肥胖、高血压（HTN）或衰老也会引起类似的异常。
本研究旨在通过聚类分析将 T2DM 患者的心脏表型与临床特征和结局联系起来。
对来自 2 个前瞻性队列的 842 例 T2DM 患者进行基线超声心动图和复合终点（心血管死亡率和住院）评估。对超声心动图变量进行聚类分析，并评估聚类与临床特征和结局的关系。
确定了 3 个聚类。第 1 组患者的左心室（LV）质量指数和早期二尖瓣流入速度与二尖瓣环早期舒张速度比值（E/e'）最低，左心室射血分数（LVEF）最高，主要为男性，肥胖或 HTN 发生率最低。第 2 组患者的应变和 E/e'比值最高，年龄最大，主要为女性，单纯 T2DM（无 HTN 或肥胖）发生率最低。第 3 组患者的 LV 质量指数和容量最高，LVEF 和应变最低，主要为男性，肥胖和 HTN 的发生率与第 1 组相似。随访 67 个月（四分位距：40 至 87）后，521 例患者中有 56 例（10.8%）发生复合终点。聚类 2（风险比：2.37；95%置信区间：1.15 至 4.88）和 3（风险比：2.19；95%置信区间：1.00 至 4.82）的结局相似，均较聚类 1 差。
超声心动图变量的聚类分析确定了 3 种不同的 T2DM 患者的超声心动图表型，与不同的临床特征相关，并突出了 LV 重构和亚临床功能障碍的预后价值。
