Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Gentofte Hospitalsvej 1, 2900 Hellerup, Denmark.
Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Gentofte Hospitalsvej 1, 2900 Hellerup, Denmark; Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 København, Denmark; Steno Diabetes Center Copenhagen, Borgmester Ib Juuls Vej 83, 2730 Herlev, Denmark.
Int J Cardiol. 2024 Feb 15;397:131653. doi: 10.1016/j.ijcard.2023.131653. Epub 2023 Dec 13.
Impaired diastolic function is a hallmark of diabetic cardiomyopathy and a common feature in type 1 diabetes mellitus (T1DM). The ratio of transmitral early filling velocity to early diastolic strain rate (E/e'sr) has in recent studies proved to have strong prognostic value. This study aimed to investigate the prognostic value of E/e'sr compared to E/e' in T1DM without known heart disease.
In this prospective cohort of T1DM patients, echocardiography was performed including two-dimensional speckle tracking. Follow-up was performed using nationwide registries. Outcomes were all-cause mortality and major cardiovascular events (MACE).
In total 1079 patients (age: 49.6 ± 14.5 years, 52.5% male, duration of diabetes 25.8 ± 14.6 years) were included in the study. During follow-up (median 6.3 years, IQR:5.7-6.9) 13.2% experienced MACE and 5.8% died. Following multivariable adjustment, both E/e'sr and E/e' was significantly associated with both MACE (E/e'sr: HR 1.16 CI95%:[1.05-1.29], p = 0.005, per 10 cm increase) vs. (E/e': HR 1.09 CI95%:[1.03-1.15], p = 0.001, per 1 unit increase) and all-cause mortality (E/e'sr: HR 1.20 [1.03-1.40], p = 0.016) vs. (E/e': HR: 1.11 [1.02-1.20], p = 0.016). Sex modified the association between E/e'sr and MACE (p for interaction = 0.008) such that E/e'sr after multivariable adjustment only remained significantly associated with MACE in females (HR: 1.41 [1.19-1.67], p < 0.001) but not in males (HR: 1.06 [0.93-1.20], p = 0.42). In females, E/e'sr provided incremental information beyond the Steno T1 Risk Engine (Harrell's C-statistic: 0.78 (0.72-0.83) vs. 0.81 (0.75-0.86), p = 0.007).
In patients with T1DM, both E/e'sr and E/e' provides independent prognostic information regarding prognosis. E/e'sr seems to have stronger prognostic value in females with T1DM.
舒张功能障碍是糖尿病心肌病的标志，也是 1 型糖尿病（T1DM）的常见特征。二尖瓣早期充盈速度与早期舒张应变率之比（E/e'sr）在最近的研究中已被证明具有很强的预后价值。本研究旨在探讨 E/e'sr 在无已知心脏病的 T1DM 患者中的预后价值。
在这项 T1DM 患者的前瞻性队列研究中，进行了超声心动图检查，包括二维斑点追踪。使用全国性登记册进行随访。结局为全因死亡率和主要心血管事件（MACE）。
共纳入 1079 例患者（年龄：49.6±14.5 岁，52.5%为男性，糖尿病病程 25.8±14.6 年）。随访期间（中位数 6.3 年，IQR：5.7-6.9），13.2%发生 MACE，5.8%死亡。多变量调整后，E/e'sr 和 E/e' 均与 MACE（E/e'sr：HR 1.16 CI95%：[1.05-1.29]，p=0.005，每增加 10cm）和全因死亡率（E/e'sr：HR 1.20 [1.03-1.40]，p=0.016）相关。E/e'：HR 1.09 CI95%：[1.03-1.15]，p=0.001，每增加 1 个单位）相关。性别改变了 E/e'sr 与 MACE 之间的相关性（p 交互=0.008），E/e'sr 经多变量调整后仅与女性的 MACE 显著相关（HR：1.41 [1.19-1.67]，p<0.001），而与男性无关（HR：1.06 [0.93-1.20]，p=0.42）。在女性中，E/e'sr 提供了超越 Steno T1 风险引擎的额外信息（Harrell's C 统计量：0.78（0.72-0.83）vs. 0.81（0.75-0.86），p=0.007）。
在 T1DM 患者中，E/e'sr 和 E/e' 均提供了独立的预后信息。E/e'sr 在女性 T1DM 患者中似乎具有更强的预后价值。
