Department of Cardiology, Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark; Department of Cardiology, Federal University of Acre, Rio Branco, Brazil.
Department of Cardiology, Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark; Faculty of Health and Medical Sciences, Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark.
J Am Soc Echocardiogr. 2021 Feb;34(2):127-135. doi: 10.1016/j.echo.2020.09.008. Epub 2020 Oct 31.
Patients with type 2 diabetes (T2D) have increased risk for subclinical myocardial disease. Early systolic lengthening (ESL), a paradoxical stretch of myocardial fibers, is a sensitive marker of myocardial dysfunction. The aims of this study were to investigate the prognostic value of ESL in patients with T2D and to determine if global longitudinal strain (GLS) modifies this relationship.
In this prospective study, speckle-tracking echocardiography was conducted in 703 patients with T2D (62% men; mean age, 63 ± 10 years; median diabetes duration, 11 years; interquartile range, 6-17 years). Patients had no histories of significant heart disease. ESL index was assessed as [-100 × (peak positive systolic strain/maximal strain)] and ESL duration as time from QRS complex on the electrocardiogram to time of peak positive systolic strain. P values ≤ .004 were considered to indicate statistical significance.
During a median follow-up time of 4.8 years (interquartile range, 4.1-5.3 years), 86 patients (12%) experienced major adverse cardiovascular events (MACE), a composite of incident heart failure, myocardial infarction, and cardiovascular death. In multivariate models, only the ESL index (hazard ratio [HR], 1.06 per 1% increase; 95% CI, 1.01-1.010; P = .004) but not ESL duration (HR, 1.02 per 1-ms increase; 95% CI, 1.00-1.03; P = .036) were associated with MACE. GLS modified this relationship (P for interaction < .05) such that in patients with low GLS (>-18%), ESL index (HR, 1.06 per 1% increase; 95% CI, 1.02-1.10; P = .003) was associated with MACE, but ESL duration was not (HR, 1.02 per 1-ms increase; 95% CI, 1.00-1.04; P = .005). No associations were found for high GLS (<-18%).
In patients with T2D and no histories of heart disease, ESL provides prognostic information on MACE and may potentially aid in cardiovascular risk stratification.
2 型糖尿病（T2D）患者发生亚临床心肌疾病的风险增加。早期收缩期伸长（ESL），即心肌纤维的反常拉伸，是心肌功能障碍的敏感标志物。本研究旨在探讨 ESL 在 T2D 患者中的预后价值，并确定整体纵向应变（GLS）是否改变了这种关系。
这是一项前瞻性研究，对 703 例 T2D 患者（62%为男性；平均年龄 63±10 岁；中位糖尿病病程 11 年；四分位距 6-17 年）进行了斑点追踪超声心动图检查。患者无重大心脏病史。ESL 指数评估为[-100×（峰值正向收缩应变/最大应变）]，ESL 持续时间评估为从心电图 QRS 复合波到峰值正向收缩应变的时间。P 值≤.004 被认为具有统计学意义。
在中位随访时间为 4.8 年（四分位距，4.1-5.3 年）期间，86 例患者（12%）发生了主要不良心血管事件（MACE），即心力衰竭、心肌梗死和心血管死亡的复合事件。在多变量模型中，只有 ESL 指数（危险比[HR]，每增加 1%，1.06；95%CI，1.01-1.010；P=.004）而不是 ESL 持续时间（HR，每增加 1ms，1.02；95%CI，1.00-1.03；P=.036）与 MACE 相关。GLS 改变了这种关系（P 交互<.05），即对于 GLS 较低（>-18%）的患者，ESL 指数（HR，每增加 1%，1.06；95%CI，1.02-1.10；P=.003）与 MACE 相关，但 ESL 持续时间与 MACE 无关（HR，每增加 1ms，1.02；95%CI，1.00-1.04；P=.005）。在 GLS 较高（<-18%）的患者中未发现相关性。
在无心脏病史的 T2D 患者中，ESL 提供了关于 MACE 的预后信息，可能有助于心血管风险分层。
