Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Niels Andersens vej 65, DK2900 Hellerup, Denmark.
Institute of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Blegdamsvej 3b, 2200 København N, Denmark.
Eur Heart J Cardiovasc Imaging. 2021 Aug 14;22(9):1017-1025. doi: 10.1093/ehjci/jeaa227.
In type 1 diabetes mellitus (T1DM), recent findings suggest that women have a greater excess risk of cardiovascular diseases (CVDs) compared to men. Impaired diastolic function is a common feature in T1DM. We investigated the association between myocardial function by echocardiography and outcomes in T1DM males and females without known heart disease.
A prospective cohort of individuals with T1DM without known heart disease from the outpatient clinic of Steno Diabetes Center Copenhagen. Follow-up was performed through Danish national registers. Outcomes, major adverse cardiovascular events (MACE) and all-cause mortality, were investigated. A total of 1079 participants (mean age: 49.6 ± 14.5 years, 52.6% male, mean duration of diabetes 25.8 ± 14.6 years) were included in the study. During follow-up (median 6.3 years, interquartile range 5.7-6.9), 142 (13.2%) experienced MACE and 63 (5.8%) died. Gender modified the relationship between E/e' and both MACE and all-cause mortality (P = 0.016 and 0.007, respectively). In females, after multivariable adjustment, both E/e' and global longitudinal strain (GLS) were significantly associated with MACE [E/e': hazard ratio (HR) 1.15 confidence interval (CI) 95%: 1.07-1.24, per 1unit increase; and GLS: HR 1.19 CI 95%: 1.04-1.35, per 1% decrease] and with all-cause mortality (E/e': HR 1.26 CI 95%: 1.11-1.44; and GLS: HR 1.27 CI 95%: 1.03-1.56). In males, the association between E/e' and GLS and outcomes did not reach statistical significance.
In female individuals with T1DM both E/e' and GLS provided independent prognostic information, whereas the associations were not significant in males. These results suggest that T1DM affects myocardial function differently in males and females, which may be related to the observed sex difference in CVD risk in T1DM.
在 1 型糖尿病（T1DM）中，最近的研究结果表明，女性患心血管疾病（CVD）的风险高于男性。舒张功能障碍是 T1DM 的常见特征。我们研究了超声心动图评估的心肌功能与无已知心脏病的 T1DM 男性和女性患者结局之间的关系。
这是一项来自哥本哈根 Steno 糖尿病中心门诊的 T1DM 无已知心脏病的前瞻性队列研究。通过丹麦国家登记处进行随访。主要心血管不良事件（MACE）和全因死亡率为研究结局。共纳入 1079 名参与者（平均年龄：49.6±14.5 岁，52.6%为男性，平均糖尿病病程：25.8±14.6 年）。随访期间（中位数 6.3 年，四分位间距 5.7-6.9 年），142 人（13.2%）发生 MACE，63 人（5.8%）死亡。性别改变了 E/e'与 MACE 和全因死亡率之间的关系（P=0.016 和 0.007）。在女性中，多变量调整后，E/e'和整体纵向应变（GLS）与 MACE 显著相关[E/e'：风险比（HR）95%置信区间（CI）为 1.07-1.24，每增加 1 个单位；GLS：HR 95%CI 为 1.04-1.35，每降低 1%]和全因死亡率（E/e'：HR 95%CI 为 1.11-1.44；GLS：HR 95%CI 为 1.03-1.56）。在男性中，E/e'和 GLS 与结局之间的关联没有达到统计学意义。
在 T1DM 女性中，E/e'和 GLS 均提供了独立的预后信息，而在男性中则无显著相关性。这些结果表明，T1DM 对男性和女性的心肌功能有不同的影响，这可能与 T1DM 中观察到的 CVD 风险的性别差异有关。
