Li Zheng, Shi Yi, Xia Yiyuan, Wu Lida, Li Hui, Zhou Rong, Gao Xiaofei, Zhang Hongsong, Jin Xiaoping, Zhang Junxia
Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, China.
Department of Intensive Medicine, Qujing No. 1 Hospital, Yuanlin No. 1 Road, Qilin District, Qujing 655000, China.
J Clin Med. 2023 Feb 16;12(4):1565. doi: 10.3390/jcm12041565.
Diabetic cardiomyopathy (DCM) is an ill-defined entity. This study aims to explore the clinical characteristics and prognosis of diabetic patients that disparately develop heart failure (HF) with preserved ejection fraction (HFpEF) other than HF with reduced ejection fraction (HFrEF).
A total of 911 patients diagnosed with diabetes mellitus were identified in the ChiHFpEF cohort (NCT05278026). DCM was defined as diabetic patients diagnosed with HF, absent from flow obstructive coronary artery disease (CAD), uncontrolled refractory hypertension and hemodynamics significant heart valvular diseases, arrhythmia and congenital heart diseases. The primary endpoint was a composite of all-cause death and rehospitalization due to HF.
As compared to DCM-HFrEF patients, DCM-HFpEF patients had a longer duration of diabetes, were older and more noticeable in hypertension and non-obstructive CAD. After a median follow-up of 45.5 months, survival analysis showed that DCM-HFpEF patients had a better composite endpoint. Cox regression implicated that non-obstructive CAD was a negative (HR 0.101, 95% CI 0.028-0.373, = 0.001) predictor for the composite endpoint of DCM-HFrEF patients. Age was a positive predictor for the composite endpoint of DCM-HFpEF patients (HR 1.044, 95% CI 1.007-1.082, = 0.018).
DCM-HFpEF is a disparate entity from DCM-HFrEF. Additional phenomic studies are needed to explore the molecular mechanisms and develop targeted therapies.
糖尿病性心肌病（DCM）是一个定义尚不明确的实体。本研究旨在探讨糖尿病患者出现射血分数保留的心力衰竭（HFpEF）而非射血分数降低的心力衰竭（HFrEF）的临床特征和预后。
在ChiHFpEF队列（NCT05278026）中识别出911例诊断为糖尿病的患者。DCM定义为诊断为HF的糖尿病患者，不存在血流阻塞性冠状动脉疾病（CAD）、未控制的难治性高血压以及血流动力学显著的心脏瓣膜疾病、心律失常和先天性心脏病。主要终点是全因死亡和因HF再次住院的复合终点。
与DCM-HFrEF患者相比，DCM-HFpEF患者糖尿病病程更长，年龄更大，高血压和非阻塞性CAD更为明显。中位随访45.5个月后，生存分析表明DCM-HFpEF患者的复合终点更好。Cox回归表明非阻塞性CAD是DCM-HFrEF患者复合终点的负向预测因素（HR 0.101，95%CI 0.028-0.373，P = 0.001）。年龄是DCM-HFpEF患者复合终点的正向预测因素（HR 1.044，95%CI 1.007-1.082，P = 0.018）。
DCM-HFpEF与DCM-HFrEF是不同的实体。需要更多的表型研究来探索分子机制并开发靶向治疗方法。
