Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands; Department of Cardiology, Princess Alexandra Hospital, Australia; The Faculty of Medicine, South Western Sydney Clinical School, The University of New South Wales, Australia.
Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
Am J Cardiol. 2019 Sep 15;124(6):892-898. doi: 10.1016/j.amjcard.2019.06.011. Epub 2019 Jul 1.
Left ventricular (LV) global longitudinal strain (GLS) can detect subclinical myocardial systolic dysfunction in individuals with diabetes. The present study investigates the clinical usefulness and incremental net benefit of identifying subclinical myocardial systolic dysfunction in individuals with diabetes. A cohort of 397 type 2 diabetic individuals was followed up for the occurrence of all-cause mortality. Clinical and echocardiographic data of diabetic patients were assessed retrospectively. LV GLS was evaluated on transthoracic echocardiography using speckle tracking imaging. Subclinical LV systolic dysfunction was defined as LV GLS > -17.0% from 104 healthy volunteers recruited from the community. A total of 178 (44.8%) diabetic individuals had evidence of subclinical LV systolic dysfunction and 46 (11.6%) died during follow-up. The presence of subclinical LV systolic dysfunction was independently associated with all-cause mortality on follow-up (hazard ratio [HR] 2.83, 95% confidence interval [CI] 1.40 to 5.71, p = 0.004). Diabetic individuals without subclinical LV systolic dysfunction had similar survival as the general population (standardized mortality ratio 0.94, 95% CI 0.52 to 1.58). Decision curve analysis showed identification of subclinical LV systolic dysfunction and quantification of LV GLS provided an incremental net clinical benefit at risk stratifying patients for risk of death at 5 years. In conclusion, subclinical LV systolic dysfunction is independently associated with all-cause mortality in diabetic patients. Decision curve analyses suggest use of LV GLS and identification of subclinical LV systolic dysfunction is clinically useful, and provided incremental net clinical benefit for diabetic individuals.
左心室（LV）整体纵向应变（GLS）可检测糖尿病患者亚临床心肌收缩功能障碍。本研究旨在探讨识别糖尿病患者亚临床心肌收缩功能障碍的临床应用价值和净临床获益。对 397 例 2 型糖尿病患者进行了全因死亡率的随访。回顾性评估糖尿病患者的临床和超声心动图数据。使用斑点追踪成像技术在经胸超声心动图上评估 LV GLS。从社区招募的 104 名健康志愿者的 LV GLS > -17.0%定义为亚临床 LV 收缩功能障碍。共有 178 名（44.8%）糖尿病患者存在亚临床 LV 收缩功能障碍，46 名（11.6%）在随访期间死亡。亚临床 LV 收缩功能障碍的存在与随访期间的全因死亡率独立相关（风险比 [HR] 2.83，95%置信区间 [CI] 1.40 至 5.71，p=0.004）。无亚临床 LV 收缩功能障碍的糖尿病患者的生存率与一般人群相似（标准化死亡率比 0.94，95%CI 0.52 至 1.58）。决策曲线分析表明，在 5 年内对死亡风险进行分层时，识别亚临床 LV 收缩功能障碍和量化 LV GLS 可提供额外的净临床获益。总之，亚临床 LV 收缩功能障碍与糖尿病患者的全因死亡率独立相关。决策曲线分析表明，LV GLS 的使用和亚临床 LV 收缩功能障碍的识别具有临床意义，并为糖尿病患者提供了额外的净临床获益。
