Department of Radiology, West China Hospital, Sichuan University, No.37 Guoxue Xiang, Chengdu, 610041, Sichuan, 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, 610041, Sichuan, China.
Cardiovasc Diabetol. 2022 Jun 4;21(1):94. doi: 10.1186/s12933-022-01533-5.
Type 2 diabetes mellitus (T2DM) increases the risk of worse long-term outcomes in patients with non-ischemic dilated cardiomyopathy (NIDCM). However, the additive effects of T2DM on left ventricular (LV) function in NIDCM remain unclear. Accordingly, we aimed to investigate the impact of comorbid T2DM on LV deformation in NIDCM individuals.
Three hundred forty-two NIDCM patients without T2DM [NIDCM (T2DM-)], 93 with T2DM [NIDCM (T2DM+)] and 80 age- and sex-matched normal controls who underwent cardiac magnetic resonance scanning were included. LV geometry, function, and LV global strains, including peak strain (PS), peak systolic strain rate (PSSR) and peak diastolic strain rate (PDSR) in the radial, circumferential and longitudinal directions, were measured. NIDCM (T2DM+) patients were divided into two subgroups based on the HbA1c level (< 7.0% and ≥ 7.0%). The determinants of reduced LV myocardial strain for all NIDCM individuals and NIDCM (T2DM+) patients were assessed using multivariable linear regression analyses.
Compared with normal controls, both NIDCM (T2DM -) and NIDCM (T2DM+) patients exhibited increased LV end-diastolic and end-systolic volume index and decreased LV ejection fraction. LV global strains progressively declined from the normal controls to the NIDCM (T2DM-) group to the NIDCM (T2DM+) group (all p < 0.017), except for radial PDSR and PSSR. Subgroup analysis showed that LV global radial PS and longitudinal PS, PSSR-L and PDSR-L were worse in NIDCM patients with poor glycemic control than in those with good glycemic control (p < 0.017). T2DM was an independent determinant of reduced LV global circumferential PS and longitudinal PS in patients with NIDCM (both p < 0.05). An increased HbA1c level was independently associated with a decreased global radial PS (β = - 0.285, p < 0.01) and longitudinal PS (β = 0.320, p < 0.01) in NIDCM (T2DM+) patients.
T2DM has an additive deleterious effect on LV systolic and diastolic function in NIDCM patients. Among NIDCM patients with T2DM, HbA1c was found to be associated with reduced LV myocardial strain.
2 型糖尿病（T2DM）会增加非缺血性扩张型心肌病（NIDCM）患者长期预后不良的风险。然而，T2DM 对 NIDCM 患者左心室（LV）功能的附加影响尚不清楚。因此，我们旨在研究合并 T2DM 对 NIDCM 个体 LV 变形的影响。
纳入 342 名无 T2DM 的 NIDCM 患者（NIDCM（T2DM-））、93 名 T2DM 患者（NIDCM（T2DM+））和 80 名年龄和性别匹配的正常对照者，他们均接受了心脏磁共振扫描。测量 LV 几何形状、功能和 LV 整体应变，包括径向、环向和纵向的峰值应变（PS）、峰值收缩期应变率（PSSR）和峰值舒张期应变率（PDSR）。根据糖化血红蛋白（HbA1c）水平（<7.0%和≥7.0%）将 NIDCM（T2DM+）患者分为两个亚组。使用多变量线性回归分析评估所有 NIDCM 个体和 NIDCM（T2DM+）患者 LV 心肌应变降低的决定因素。
与正常对照组相比，NIDCM（T2DM-）和 NIDCM（T2DM+）患者的 LV 舒张末期和收缩末期容积指数增加，LV 射血分数降低。LV 整体应变从正常对照组到 NIDCM（T2DM-）组再到 NIDCM（T2DM+）组逐渐降低（均 p<0.017），除了径向 PDSR 和 PSSR。亚组分析显示，血糖控制不佳的 NIDCM 患者的 LV 整体径向 PS 和纵向 PS、PSSR-L 和 PDSR-L 均较血糖控制良好的患者差（均 p<0.017）。T2DM 是 NIDCM 患者 LV 整体环向 PS 和纵向 PS 降低的独立决定因素（均 p<0.05）。HbA1c 水平升高与 NIDCM（T2DM+）患者的整体径向 PS（β=-0.285，p<0.01）和纵向 PS（β=0.320，p<0.01）降低独立相关。
T2DM 对 NIDCM 患者的 LV 收缩和舒张功能有附加的有害影响。在合并 T2DM 的 NIDCM 患者中，HbA1c 与 LV 心肌应变降低有关。
