Jiang Li, Wang Jin, Liu Xi, Li Zhen-Lin, Xia Chun-Chao, Xie Lin-Jun, Gao Yue, Shen Meng-Ting, Han Pei-Lun, Guo Ying-Kun, Yang Zhi-Gang
Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, Sichuan 610041, China; Department of Radiology, Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, West China Second University Hospital, Sichuan University, 20# South Renmin Road, Chengdu, Sichuan 610041, China.
Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, Sichuan 610041, China.
Int J Cardiol. 2020 Dec 1;320:112-118. doi: 10.1016/j.ijcard.2020.07.013. Epub 2020 Jul 15.
Diabetes mellitus-related cardiomyopathy has recently been described as a distinct progression of left ventricular (LV) systolic and diastolic dysfunction. Pathological changes in the myocardium may explain the development of two different phenotypes. We evaluated the effects of LV geometry, myocardial microcirculation, and tissue characteristics on cardiac deformation in patients with subclinical type 2 diabetes mellitus (T2DM) utilizing multiparametric cardiac magnetic resonance (CMR) imaging.
A total of 135 T2DM patients and 55 matched controls were prospectively enrolled and performed multiparametric CMR examination. CMR-derived parameters including cardiac geometry, function, microvascular perfusion, T1 mapping, T2 mapping, and strain were analyzed and compared between T2DM patients and controls.
The univariable and multivariable analysis of systolic and diastolic function revealed that longer duration of diabetes was associated with decreased longitudinal peak systolic strain rate (PSSR-L) (β = 0.195, p = .013), and higher remodeling index and higher extracellular volume (ECV) tended to correlate with decreased longitudinal peak diastolic strain rate (PDSR-L) (remodeling index, β = -0.339, p = .000; ECV, β = -0.172, p = .026), whereas microvascular perfusion index and T2 value affected both PSSR-L (perfusion index, β = -0.328, p = .000; T2 value, β = 0.306, p = .000) and PDSR-L (perfusion index, β = 0.209, p = .004; T2 value, β = -0.275, p = .000) simultaneously.
The LV concentric remodeling and myocardial fibrosis correlated with diastolic function, and perfusion function and myocardial edema were associated with both LV systolic and diastolic function.
糖尿病相关心肌病最近被描述为左心室（LV）收缩和舒张功能障碍的一种独特进展。心肌的病理变化可能解释两种不同表型的发展。我们利用多参数心脏磁共振（CMR）成像评估了亚临床2型糖尿病（T2DM）患者左心室几何形态、心肌微循环和组织特征对心脏变形的影响。
前瞻性纳入135例T2DM患者和55例匹配对照，进行多参数CMR检查。分析并比较T2DM患者和对照之间CMR衍生参数，包括心脏几何形态、功能、微血管灌注、T1映射、T2映射和应变。
收缩和舒张功能的单变量和多变量分析显示，糖尿病病程较长与纵向收缩期峰值应变率（PSSR-L）降低相关（β = 0.195，p = 0.013），较高的重构指数和较高的细胞外容积（ECV）倾向于与纵向舒张期峰值应变率（PDSR-L）降低相关（重构指数，β = -0.339，p = 0.000；ECV，β = -0.172，p = 0.026），而微血管灌注指数和T2值同时影响PSSR-L（灌注指数，β = -0.328，p = 0.000；T2值，β = 0.306，p = 0.000）和PDSR-L（灌注指数，β = 0.209，p = 0.004；T2值，β = -0.275，p = 0.000）。
左心室向心性重构和心肌纤维化与舒张功能相关，灌注功能和心肌水肿与左心室收缩和舒张功能均相关。
