胰岛素使用与心力衰竭和射血分数降低的糖尿病患者左心室重构和临床结局的关系：心脏 MRI 评估。

Association of insulin use with LV remodeling and clinical outcomes in diabetic patients with heart failure and reduced ejection fraction: assessed by cardiac MRI.

机构信息

Department of Radiology, Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, Sichuan, China.

Department of Radiology, Sichuan Cancer Center, School of Medicine, Sichuan Cancer Hospital and Institute, University of Electronic Science and Technology of China, Chengdu, Sichuan, China.

出版信息

Cardiovasc Diabetol. 2023 Aug 4;22(1):201. doi: 10.1186/s12933-023-01944-y.

DOI:10.1186/s12933-023-01944-y

PMID:37542280

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10403944/

Abstract

BACKGROUND

Insulin is commonly used in type 2 diabetes mellitus (T2DM) to achieve glycemic control. However, recent evidence showed that insulin use is associated with poor outcomes in the context of heart failure (HF). Since heart failure with reduced ejection fraction (HFrEF) accounts for approximately 50% of cases in the general HF population, we aimed to evaluate the effect of insulin treatment on left ventricular (LV) remodeling and contractility abnormalities in a HFrEF cohort and assess whether insulin was a predictor of adverse outcomes in this entity.

METHODS

A total of 377 HFrEF patients who underwent cardiac MRI were included and divided according to diabetes status and the need for insulin treatment. LV structural and functional indices, as well as systolic strains, were measured. The determinants of impaired myocardial strains were assessed using linear regression analysis. The associated endpoints were determined using a multivariable Cox proportional hazards model.

RESULTS

T2DM patients on insulin displayed a higher indexed LV end-diastolic volume and LV mass than those with T2DM not on insulin or those without T2DM, despite similar LV ejection fractions, accompanied by a higher three-dimensional spherical index (P < 0.01). Worse longitudinal and circumferential peak systolic strain was shown to occur in T2DM patients on insulin (P < 0.01). Insulin treatment was independently associated with impaired magnitudes of systolic strain. The median follow-up duration was 32.4 months (IQR, 15.6-43.2 months). Insulin treatment remained consistently associated with poor outcomes after adjustment for established confounders, with an adjusted hazard ratio of 3.11; (95% CI, 1.45-6.87; P = 0.009) in the overall cohort and 2.16 (95% CI, 1.08-4.59; P = 0.030) in the diabetes cohort.

CONCLUSIONS

Insulin may further lead to adverse LV remodeling and contractile dysfunction in the context of HFrEF with T2DM. Considerable care should be taken when treating HFrEF patients with insulin.

摘要

背景

胰岛素常用于 2 型糖尿病（T2DM）以实现血糖控制。然而，最近的证据表明，在心力衰竭（HF）的背景下，胰岛素的使用与不良结局相关。由于射血分数降低的心力衰竭（HFrEF）约占一般心力衰竭人群的 50%，我们旨在评估胰岛素治疗对 HFrEF 患者左心室（LV）重构和收缩功能异常的影响，并评估胰岛素是否是该实体不良结局的预测因素。

方法

共纳入 377 例接受心脏 MRI 的 HFrEF 患者，并根据糖尿病状态和胰岛素治疗需求进行分组。测量 LV 结构和功能指标以及收缩期应变。使用线性回归分析评估心肌应变受损的决定因素。使用多变量 Cox 比例风险模型确定相关终点。

结果

尽管 LV 射血分数相似，但使用胰岛素的 T2DM 患者的 LV 末期容积和 LV 质量指数高于未使用胰岛素或无 T2DM 的患者，同时伴有更高的三维球形指数（P<0.01）。使用胰岛素的 T2DM 患者的纵向和圆周收缩期峰值应变更差（P<0.01）。胰岛素治疗与收缩期应变幅度受损独立相关。中位随访时间为 32.4 个月（IQR，15.6-43.2 个月）。在调整了既定混杂因素后，胰岛素治疗与不良结局持续相关，调整后的危险比为 3.11（95%CI，1.45-6.87；P=0.009），在整个队列中和 2.16（95%CI，1.08-4.59；P=0.030）在糖尿病队列中。