Department of Cardiology, Princess Alexandra Hospital, The University of Queensland, Woolloongabba, Australia; Translational Research Institute, Brisbane, Australia; Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands; University of Padua, Department of Cardiac, Thoracic and Vascular Sciences, Padova, Italy.
J Am Soc Echocardiogr. 2018 Aug;31(8):916-925. doi: 10.1016/j.echo.2018.02.012.
Diabetes and obesity are both worldwide growing epidemics, and both are independently associated with increased risk for heart failure and death. The aim of this study was to examine the additive detrimental effect of both diabetes and increasing body mass index (BMI) category on left ventricular (LV) myocardial systolic and diastolic function.
The present retrospective multicenter study included 653 patients (337 with type 2 diabetes and 316 without diabetes) of increasing BMI category. All patients had normal LV ejection fractions. LV myocardial systolic (peak systolic global longitudinal strain and peak systolic global longitudinal strain rate) and diastolic (average mitral annular e' velocity and early diastolic global longitudinal strain rate) function was quantified using echocardiography.
Increasing BMI category was associated with progressively more impaired LV myocardial function in patients with diabetes (P < .001). Patients with diabetes had significantly more impaired LV myocardial function for all BMI categories compared with those without diabetes (P < .001). On multivariate analysis, both diabetes and obesity were independently associated with an additive detrimental effect on LV myocardial systolic and diastolic function. However, obesity was associated with greater LV myocardial dysfunction than diabetes.
Both diabetes and increasing BMI category had an additive detrimental effect on LV myocardial systolic and diastolic function. Furthermore, increasing BMI category was associated with greater LV myocardial dysfunction than diabetes. As they frequently coexist together, future studies on patients with diabetes should also focus on obesity.
糖尿病和肥胖症都是全球性的流行疾病，两者都与心力衰竭和死亡风险增加独立相关。本研究旨在探讨糖尿病和体重指数（BMI）类别增加对左心室（LV）心肌收缩和舒张功能的累加不良影响。
本回顾性多中心研究纳入了 653 名 BMI 逐渐增加的患者（337 名 2 型糖尿病患者和 316 名非糖尿病患者）。所有患者的 LV 射血分数均正常。使用超声心动图定量评估 LV 心肌收缩（收缩期整体纵向应变峰值和收缩期整体纵向应变率峰值）和舒张功能（二尖瓣环平均 e'速度和舒张早期整体纵向应变率）。
随着 BMI 类别的增加，糖尿病患者的 LV 心肌功能逐渐受损（P<.001）。与无糖尿病患者相比，所有 BMI 类别中糖尿病患者的 LV 心肌功能明显受损（P<.001）。多变量分析显示，糖尿病和肥胖均与 LV 心肌收缩和舒张功能的累加不良影响独立相关。然而，肥胖与更大的 LV 心肌功能障碍相关，而糖尿病则不然。
糖尿病和 BMI 类别增加对 LV 心肌收缩和舒张功能均有累加不良影响。此外，BMI 类别的增加与更大的 LV 心肌功能障碍相关，而糖尿病则不然。由于它们经常同时存在，未来针对糖尿病患者的研究也应关注肥胖问题。
