Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
Menzies Institute for Medical Research, Imaging Research, Hobart, Tasmania, Australia.
JACC Cardiovasc Imaging. 2021 Feb;14(2):350-361. doi: 10.1016/j.jcmg.2020.09.032. Epub 2020 Nov 18.
The determinants of changes in systolic and diastolic parameters in patients age >65 years, at risk of heart failure (HF), and with and without asymptomatic type 2 diabetes mellitus (T2DM) was assessed by echocardiography. The association between metformin and myocardial function was also assessed.
The increasing prevalence of T2DM will likely further fuel the epidemic of HF. Understanding the development or progression of left ventricular (LV) dysfunction may inform effective measures for HF prevention.
A total of 982 patients with at least one HF risk factor (hypertension, obesity, or T2DM) were recruited from 2 community-based populations and divided into 2 groups: T2DM (n = 431, age 71 ± 4 years) and non-T2DM (n = 551, age 71 ± 5 years). Associations of metformin therapy were evaluated in the T2DM group. All underwent a comprehensive echocardiogram, including global longitudinal strain (GLS) and diastolic function (transmitral flow [E], annular velocity [e']) at baseline and follow-up (median 19 months [interquartile range: 17 to 26 months]). Comparisons were facilitated by propensity matching.
A reduction in GLS was observed in the T2DM group (baseline -17.8 ± 2.6% vs. follow-up -17.4 ± 2.8%; p = 0.003), but not in the non-T2DM group (-18.7 ± 2.7% vs. -18.6 ± 3.0%; p = 0.41). Estimated LV filling pressures increased in both the T2DM group (p = 0.001) and the non-T2DM group (p = 0.04). Metformin-treated patients with T2DM did not increase estimated LV filling pressure (E/e' baseline 8.9 ± 2.7 vs. follow-up 9.1 ± 2.7; p = 0.485) or change e' (7.6 ± 1.5 cm/s vs. 7.6 ± 1.8 cm/s; p = 0.88). After propensity matching, metformin was associated with a smaller change in e' (β = 0.58 [95% CI: 0.13 to 1.03]; p = 0.013) and E/e' (β = -0.96 [95% CI: -1.66 to -0.26]; p = 0.007) but was not associated with a change in GLS (p = 0.46).
Over 2 years, there is a worsening of GLS and LV filling pressures in asymptomatic diabetic patients with HF risk factors. Metformin use is associated with less deterioration of LV filling pressures and myocardial relaxation but had no association with systolic function.
通过超声心动图评估 65 岁以上、有心力衰竭（HF）风险且有或无无症状 2 型糖尿病（T2DM）的患者收缩压和舒张压参数变化的决定因素。还评估了二甲双胍与心肌功能的关系。
T2DM 的患病率不断上升，可能会进一步推动 HF 的流行。了解左心室（LV）功能障碍的发展或进展可能会为 HF 的预防提供有效措施。
从 2 个基于社区的人群中招募了 982 名至少有 1 个 HF 危险因素（高血压、肥胖或 T2DM）的患者，分为 2 组：T2DM（n=431，年龄 71±4 岁）和非 T2DM（n=551，年龄 71±5 岁）。在 T2DM 组中评估了二甲双胍治疗的相关性。所有患者均在基线和随访（中位数 19 个月[四分位距：17 至 26 个月]）时接受了全面的超声心动图检查，包括整体纵向应变（GLS）和舒张功能（经二尖瓣血流 [E]、瓣环速度[e']）。通过倾向评分匹配来促进比较。
T2DM 组的 GLS 降低（基线-17.8±2.6% vs. 随访-17.4±2.8%；p=0.003），而非 T2DM 组则没有（-18.7±2.7% vs. -18.6±3.0%；p=0.41）。两组的 LV 充盈压估计值均增加（T2DM 组 p=0.001，非 T2DM 组 p=0.04）。接受 T2DM 二甲双胍治疗的患者的 LV 充盈压估计值没有增加（E/e' 基线 8.9±2.7 vs. 随访 9.1±2.7；p=0.485）或 e' 变化（7.6±1.5 cm/s vs. 7.6±1.8 cm/s；p=0.88）。经过倾向评分匹配后，二甲双胍与 e'（β=0.58[95%CI：0.13 至 1.03]；p=0.013）和 E/e'（β=-0.96[95%CI：-1.66 至-0.26]；p=0.007）的变化较小相关，但与 GLS 变化无关（p=0.46）。
在 2 年的时间里，有 HF 风险因素的无症状糖尿病患者的 GLS 和 LV 充盈压恶化。二甲双胍的使用与 LV 充盈压和心肌舒张恶化程度降低相关，但与收缩功能无关。
