Radiology and Imaging Sciences, Clinical Center, National Institutes of Health Bethesda, Maryland.
The Biostatistics Center, The George Washington University, Rockville, Maryland.
Am J Cardiol. 2022 Jul 1;174:158-165. doi: 10.1016/j.amjcard.2022.03.036. Epub 2022 Apr 29.
Alterations in myocardial structure, function, tissue composition (e.g., fibrosis) may be associated with metabolic syndrome (MetS). This study aimed to determine the relation of MetS and its individual components to markers of cardiovascular disease in patients with type 1 Diabetes Mellitus (T1DM). A total of 978 subjects of the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications T1DM cohort (age: 49 ± 7 years, 47% female, DM duration 28 ± 5 years) underwent cardiovascular magnetic resonance. In a subset of 200 patients, myocardial tissue composition was measured with cardiovascular magnetic resonance T1 mapping after contrast administration. MetS was defined as T1DM plus 2 other abnormalities based on the American Heart Association/National Cholesterol Education Program criteria. MetS was present in 34.1% of subjects. After adjustment for age, height, scanner, study cohort, gender, smoking, mean glycated hemoglobin levels, history of macroalbuminuria and end-stage renal disease, left ventricle mass was greater by 12.3 g, end-diastolic volume was higher by 5.4 ml, and mass to end-diastolic volume ratio was higher by 5% in patients with MetS versus those without MetS (p <0.001 for all). Myocardial T1 times were lower by 29 ms in patients with MetS than those without (p <0.001). Elevated waist circumference showed the strongest associations with left ventricle mass (+10.1 g), end-diastolic volume (+6.7 ml), and lower myocardial T1 times (+31 ms) in patients with MetS compared with those without (p <0.01). In conclusion, in a large cohort of patients with T1DM, 34.1% of subjects met MetS criteria. MetS was associated with adverse myocardial structural remodeling and change in myocardial tissue composition.
心肌结构、功能和组织成分（如纤维化）的改变可能与代谢综合征（MetS）有关。本研究旨在确定代谢综合征及其各个组成部分与 1 型糖尿病（T1DM）患者心血管疾病标志物的关系。共有 978 名糖尿病控制和并发症试验/糖尿病干预和并发症 T1DM 队列的受试者（年龄：49±7 岁，47%为女性，糖尿病病程 28±5 年）接受了心血管磁共振检查。在 200 名患者的亚组中，通过对比剂给药后进行心血管磁共振 T1 映射测量心肌组织成分。代谢综合征根据美国心脏协会/国家胆固醇教育计划标准定义为 T1DM 加上其他 2 种异常。34.1%的受试者存在代谢综合征。在校正年龄、身高、扫描仪、研究队列、性别、吸烟、平均糖化血红蛋白水平、白蛋白尿和终末期肾病史后，与无代谢综合征患者相比，代谢综合征患者的左心室质量增加 12.3g，舒张末期容积增加 5.4ml，质量与舒张末期容积比增加 5%（所有 p<0.001）。代谢综合征患者的心肌 T1 时间比无代谢综合征患者低 29ms（p<0.001）。与无代谢综合征患者相比，代谢综合征患者的腰围升高与左心室质量（增加 10.1g）、舒张末期容积（增加 6.7ml）和较低的心肌 T1 时间（增加 31ms）的相关性最强（所有 p<0.01）。总之，在 T1DM 的大型患者队列中，34.1%的患者符合代谢综合征标准。代谢综合征与不良的心肌结构重塑和心肌组织成分改变有关。
