Zoppini Giacomo, Bergamini Corinna, Bonapace Stefano, Trombetta Maddalena, Mantovani Alessandro, Toffalini Anna, Lanzoni Laura, Bertolini Lorenzo, Zenari Luciano, Bonora Enzo, Targher Giovanni, Rossi Andrea
Department of Medicine, Section of Endocrinology, Diabetes and Metabolism, Azienda Ospedaliera Universitaria Integrata, University of Verona, Verona, Italy.
Department of Medicine, Section of Cardiology, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy.
BMJ Open Diabetes Res Care. 2018 Jun 14;6(1):e000529. doi: 10.1136/bmjdrc-2018-000529. eCollection 2018.
Type 2 diabetes may alter cardiac structure and function. Many patients with type 2 diabetes have diastolic dysfunction with preserved ejection fraction (EF). Recently, this latter measure was criticised. Thus, this research looked at the impact of left ventricular end-diastolic volume and E/e' ratio variations in patients with type 2 diabetes and preserved EF with the aim to recognise different clinical phenotypes.
In this cross-sectional study, we evaluated 176 men affected by type 2 diabetes with transthoracic echocardiography. All subjects have preserved EF (>50%). Patients were stratified into four groups based on the median value of both left ventricular end-diastolic volume and E/e' ratio, and the clinical variables were registered. The independent predictors associated with the groups were analysed by a multinomial logistic regression model.
Diabetes duration, age, estimated glomerular filtration rate and antihypertensive treatments were significantly different among the groups as were EF, left atrial volume index (LAVI), E/A, septum thickness and s' mean wave. Multinomial regression analysis showed that the groups significantly differed for age, diabetes duration, EF, LAVI, septum thickness and s' mean wave. The main result of this study was that patients with higher left ventricular volume and higher E/e' ratio (group 2) showed the worse clinical profile.
Our study might suggest that variations of left ventricular end-diastolic volume along with E/e' ratio variations, even in the normal range, may allow to recognise phenotypes of patients with type 2 diabetes with worse clinical characteristics. This finding should be tested in prospective studies to assess the predictive roles of these phenotypes.
2型糖尿病可能会改变心脏结构和功能。许多2型糖尿病患者存在射血分数（EF）保留的舒张功能障碍。最近，这一指标受到了批评。因此，本研究探讨了2型糖尿病且EF保留患者左心室舒张末期容积和E/e'比值变化的影响，旨在识别不同的临床表型。
在这项横断面研究中，我们通过经胸超声心动图评估了176名2型糖尿病男性患者。所有受试者的EF均保留（>50%）。根据左心室舒张末期容积和E/e'比值的中位数将患者分为四组，并记录临床变量。通过多项逻辑回归模型分析与各组相关的独立预测因素。
各组之间的糖尿病病程、年龄、估计肾小球滤过率和降压治疗存在显著差异，EF、左心房容积指数（LAVI）、E/A、室间隔厚度和s'平均波也存在显著差异。多项回归分析表明，各组在年龄、糖尿病病程、EF、LAVI、室间隔厚度和s'平均波方面存在显著差异。本研究的主要结果是，左心室容积较高且E/e'比值较高的患者（第2组）表现出更差的临床特征。
我们的研究可能表明，即使在正常范围内，左心室舒张末期容积的变化以及E/e'比值的变化，可能有助于识别具有更差临床特征的2型糖尿病患者的表型。这一发现应在前瞻性研究中进行验证，以评估这些表型的预测作用。
