2型糖尿病合并缺血性和非缺血性扩张型心肌病患者左心室纵向功能及心肌纤维化的预后价值：一项3.0T心脏磁共振研究

Prognostic Value of Left Ventricular Longitudinal Function and Myocardial Fibrosis in Patients With Ischemic and Non-Ischemic Dilated Cardiomyopathy Concomitant With Type 2 Diabetes Mellitus: A 3.0 T Cardiac MR Study.

作者信息

Zhang Hong-Kai, Du Yu, Shi Chun-Yan, Zhang Nan, Gao Hui-Qiang, Zhong Yong-Liang, Wang Mao-Zhou, Zhou Zhen, Gao Xue-Lian, Li Shuang, Yang Lin, Liu Tong, Fan Zhan-Ming, Sun Zhong-Hua, Xu Lei

机构信息

Department of Radiology, Beijing Anzhen Hospital, Beijing Institute of Heart, Lung, and Vascular Diseases, Capital Medical University, Beijing, China.

Department of Cardiology, Clinical Center for Coronary Heart Disease, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.

出版信息

J Magn Reson Imaging. 2024 Jan;59(1):164-176. doi: 10.1002/jmri.28723. Epub 2023 Apr 4.

DOI:10.1002/jmri.28723

PMID:37013673

Abstract

BACKGROUND

Poorly controlled type 2 diabetes mellitus (T2DM) is known to result in left ventricular (LV) dysfunction, myocardial fibrosis, and ischemic/nonischemic dilated cardiomyopathy (ICM/NIDCM). However, less is known about the prognostic value of T2DM on LV longitudinal function and late gadolinium enhancement (LGE) assessed with cardiac MRI in ICM/NIDCM patients.

PURPOSE

To measure LV longitudinal function and myocardial scar in ICM/NIDCM patients with T2DM and to determine their prognostic values.

STUDY TYPE

Retrospective cohort.

POPULATION

Two hundred thirty-five ICM/NIDCM patients (158 with T2DM and 77 without T2DM).

FIELD STRENGTH/SEQUENCE: 3T; steady-state free precession cine; phase-sensitive inversion recovery segmented gradient echo LGE sequences.

ASSESSMENT

Global peak longitudinal systolic strain rate (GLPSSR) was evaluated to LV longitudinal function with feature tracking. The predictive value of GLPSSR was determined with ROC curve. Glycated hemoglobin (HbA1c) was measured. The primary adverse cardiovascular endpoint was follow up every 3 months.

STATISTICAL TESTS

Mann-Whitney U test or student's t-test; Intra and inter-observer variabilities; Kaplan-Meier method; Cox proportional hazards analysis (threshold = 5%).

RESULTS

ICM/NIDCM patients with T2DM exhibited significantly lower absolute value of GLPSSR (0.39 ± 0.14 vs. 0.49 ± 0.18) and higher proportion of LGE positive (+) despite similar LV ejection fraction, compared to without T2DM. LV GLPSSR was able to predict primary endpoint (AUC 0.73) and optimal cutoff point was 0.4. ICM/NIDCM patients with T2DM (GLPSSR < 0.4) had more markedly impaired survival. Importantly, this group (GLPSSR < 0.4, HbA1c ≥ 7.8%, or LGE (+)) exhibited the worst survival. In multivariate analysis, GLPSSR, HbA1c, and LGE (+) significantly predicted primary adverse cardiovascular endpoint in overall ICM/NIDCM and ICM/NIDCM patients with T2DM.

CONCLUSIONS

T2DM has an additive deleterious effect on LV longitudinal function and myocardial fibrosis in ICM/NIDCM patients. Combining GLPSSR, HbA1c, and LGE could be promising markers in predicting outcomes in ICM/NIDCM patients with T2DM.

EVIDENCE LEVEL

3 TECHNICAL EFFICACY: 5.

摘要

背景

已知2型糖尿病（T2DM）控制不佳会导致左心室（LV）功能障碍、心肌纤维化以及缺血性/非缺血性扩张型心肌病（ICM/NIDCM）。然而，对于T2DM对ICM/NIDCM患者左心室纵向功能及心脏磁共振成像评估的晚期钆增强（LGE）的预后价值了解较少。

目的

测量合并T2DM的ICM/NIDCM患者的左心室纵向功能和心肌瘢痕，并确定其预后价值。

研究类型

回顾性队列研究。

研究对象

235例ICM/NIDCM患者（158例合并T2DM，77例未合并T2DM）。

场强/序列：3T；稳态自由进动电影序列；相位敏感反转恢复分段梯度回波LGE序列。

评估

采用特征跟踪技术评估左心室纵向功能的整体峰值纵向收缩应变率（GLPSSR）。通过ROC曲线确定GLPSSR的预测价值。测量糖化血红蛋白（HbA1c）。每3个月随访一次主要不良心血管终点事件。

统计分析

曼-惠特尼U检验或学生t检验；观察者内和观察者间变异性；Kaplan-Meier法；Cox比例风险分析（阈值 = 5%）。

结果

与未合并T2DM的ICM/NIDCM患者相比，合并T2DM的患者尽管左心室射血分数相似，但GLPSSR绝对值显著降低（0.39±0.14对0.49±0.18），LGE阳性（+）比例更高。左心室GLPSSR能够预测主要终点事件（AUC 0.73），最佳截断点为0.4。合并T2DM（GLPSSR < 0.4）的ICM/NIDCM患者生存受损更明显。重要的是，该组（GLPSSR < 0.4、HbA1c≥7.8%或LGE（+））生存最差。多因素分析显示，GLPSSR、HbA1c和LGE（+）在总体ICM/NIDCM患者及合并T2DM的ICM/NIDCM患者中均显著预测主要不良心血管终点事件。