Menzies Institute for Medical Research, Hobart, Australia.
Menzies Institute for Medical Research, Hobart, Australia; Baker Heart and Diabetes Institute, Melbourne, Australia.
JACC Cardiovasc Imaging. 2018 Oct;11(10):1390-1400. doi: 10.1016/j.jcmg.2018.03.015. Epub 2018 May 16.
This study sought to identify whether impaired global longitudinal strain (GLS), diastolic dysfunction (DD), or left atrial enlargement (LAE) should be added to stage B heart failure (SBHF) criteria in asymptomatic patients with type 2 diabetes mellitus.
SBHF is a precursor to clinical heart failure (HF), and its recognition justifies initiation of cardioprotective therapy. However, original definitions of SBHF were based on LV hypertrophy and impaired ejection fraction.
Patients with asymptomatic type 2 diabetes mellitus ≥65 years of age (age 71 ± 4 years; 55% men) with preserved ejection fraction and no ischemic heart disease were recruited from a community-based population. All underwent a standard clinical evaluation, and a comprehensive echocardiogram, including assessment of left ventricular hypertrophy (LVH), LAE, DD (abnormal E/e'), and GLS (<16%). Over a median follow-up of 1.5 years (range 0.5 to 3), 20 patients were lost to follow-up, and 290 individuals were entered into the final analyses.
In this asymptomatic group, LV dysfunction was identified in 30 (10%) by DD, 68 (23%) by LVH, 102 (35%) by LAE, and 68 (23%) by impaired GLS. New-onset HF developed in 45 patients and 4 died, giving an event rate of 112/1,000 person-years. Survival free of the composite endpoint (HF and death) was about 1.5-fold higher in patients without a normal, compared with an abnormal echocardiogram. LVH, LAE, and GLS <16% were associated with increased risk of the composite endpoint, independent of ARIC risk score and glycosylated hemoglobin, but abnormal E/e' was not. The addition of left atrial volume and GLS provided incremental value to the current standard of clinical risk (ARIC score) and LVH. In a competing-risks regression analysis, LVH (hazard ratio: 2.90; p < 0.001) and GLS <16% (hazard ratio: 2.26; p = 0.008), but not DD and LAE were associated with incident HF.
Subclinical left ventricular systolic dysfunction is prevalent in asymptomatic elderly patients with type 2 diabetes mellitus, and impaired GLS is independent and incremental to LVH in the prediction of incident HF.
本研究旨在探讨对于无症状 2 型糖尿病患者，是否应将局部纵向应变（GLS）受损、舒张功能障碍（DD）或左心房扩大（LAE）加入到 B 期心力衰竭（SBHF）标准中。
SBHF 是临床心力衰竭（HF）的前兆，识别 SBHF 可证明启动心脏保护治疗的合理性。然而，SBHF 的最初定义是基于左心室肥厚和射血分数降低。
本研究纳入了年龄≥65 岁（71±4 岁；55%为男性）、无缺血性心脏病且射血分数正常的社区人群中无症状 2 型糖尿病患者。所有患者均接受了标准的临床评估以及全面的超声心动图检查，包括左心室肥厚（LVH）、LAE、DD（异常 E/e'）和 GLS（<16%）的评估。中位随访时间为 1.5 年（0.5-3 年），共有 20 例患者失访，290 例患者纳入最终分析。
在这个无症状的患者群体中，通过 DD 发现 30 例（10%）存在左室功能障碍，68 例（23%）存在 LVH，102 例（35%）存在 LAE，68 例（23%）存在 GLS 降低。45 例患者新发 HF，4 例死亡，发生率为 112/1000 人年。与超声心动图异常的患者相比，无正常超声心动图的患者发生复合终点（HF 和死亡）的风险低约 1.5 倍。LVH、LAE 和 GLS<16%与复合终点风险增加相关，独立于 ARIC 风险评分和糖化血红蛋白，但异常 E/e'则不然。左心房容积和 GLS 的加入为当前临床风险（ARIC 评分）和 LVH 的标准提供了额外的价值。在竞争风险回归分析中，LVH（风险比：2.90；p<0.001）和 GLS<16%（风险比：2.26；p=0.008），而非 DD 和 LAE，与 HF 事件相关。
亚临床左心室收缩功能障碍在无症状的老年 2 型糖尿病患者中较为常见，GLS 受损与 LVH 一样，是 HF 事件的独立且增量预测因子。
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