Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Kildegårdsvej 28, Hellerup DK, Denmark.
Steno Diabetes Center Copenhagen, University of Copenhagen, Niels Steensens Vej 2, Gentofte DK, Denmark.
Eur Heart J Cardiovasc Imaging. 2019 Jun 1;20(6):687-693. doi: 10.1093/ehjci/jey164.
Echocardiography is suggested in the diagnostic work-up of patients with Type 2 diabetes (T2D). We investigated which echocardiographic parameters that best predicted cardiovascular disease (CVD) and whether this was persistent in both genders in a large cohort of outpatients with T2D.
We performed comprehensive echocardiography in 933 patients with T2D followed at specialized out-patients clinics in Copenhagen, Denmark. Follow-up was performed using national registries and included admission with future CVD events and non-CVD death as competing risk. Median follow-up was 4.8 years and 138 CVD events occurred. In univariable and multivariable analyses, a wide range of structural, diastolic, and systolic measurements predicted CVD including mean E/e' [hazard ratio (HR) 1.06, 95% confidence interval: (1.03-1.10), P < 0.001, C-statistics 0.74 (0.70-0.78)] and global longitudinal strain (GLS) [1.10 (1.01-1.20), P = 0.03, C-statistics 0.73 (0.69-0.77)]. However, this was modified by gender. In men, mean E/e' remained the strongest predictor in multivariable analyses and performed best measured by highest C-statistics [HR 1.15, 95% confidence interval: (1.08-1.21), P < 0.001, C-statistics 0.75 (0.71-0.80)] whereas in women this was GLS [1.39 (1.14-1.70), P = 0.001, C-statistics 0.79 (0.70-0.87)]. These findings persisted when excluding patients with known heart disease and when regarding all-cause mortality as a competing risk.
A range of echocardiographic parameters predicted CVD in patients with Type 2 diabetes, however, in multivariable analyses, mean E/e' was the strongest predictor and had the highest model performance. Importantly, this study identifies a hitherto undescribed gender interaction as mean E/e' performed best in men, whereas in women this was GLS.
超声心动图被建议用于 2 型糖尿病（T2D）患者的诊断。我们研究了哪些超声心动图参数可以最好地预测心血管疾病（CVD），以及在丹麦哥本哈根专门的门诊接受治疗的大量 T2D 患者中，这些参数在男女中是否具有持续性。
我们对 933 例 T2D 患者进行了全面的超声心动图检查，这些患者在丹麦哥本哈根的专门门诊接受治疗。使用国家登记册进行随访，包括因未来 CVD 事件和非 CVD 死亡而入院作为竞争风险。中位随访时间为 4.8 年，发生了 138 例 CVD 事件。在单变量和多变量分析中，广泛的结构、舒张和收缩测量值预测了 CVD，包括平均 E/e'[风险比（HR）1.06，95%置信区间：（1.03-1.10），P<0.001，C 统计量 0.74（0.70-0.78）]和整体纵向应变（GLS）[1.10（1.01-1.20），P=0.03，C 统计量 0.73（0.69-0.77）]。然而，这受到了性别的影响。在男性中，平均 E/e'在多变量分析中仍然是最强的预测因子，并且在最高的 C 统计量下表现最好[HR 1.15，95%置信区间：（1.08-1.21），P<0.001，C 统计量 0.75（0.71-0.80）]，而在女性中，这是 GLS[1.39（1.14-1.70），P=0.001，C 统计量 0.79（0.70-0.87）]。当排除已知心脏病患者和将全因死亡率作为竞争风险时，这些发现仍然存在。
一系列超声心动图参数可预测 2 型糖尿病患者的 CVD，但在多变量分析中，平均 E/e'是最强的预测因子，且模型性能最高。重要的是，这项研究发现了一种迄今未被描述的性别相互作用，即平均 E/e'在男性中表现最佳，而在女性中则是 GLS。
