Department of Cardiology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, P. R. China.
Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.
Cardiovasc Diabetol. 2024 Feb 1;23(1):48. doi: 10.1186/s12933-024-02134-0.
The impact of the coexistence of type 2 diabetes mellitus (T2DM) in patients with non-ischemic dilated cardiomyopathy (DCM) on clinical profiles, myocardial fibrosis, and outcomes remain incompletely understood.
A total of 1152 patients diagnosed with non-ischemic DCM were prospectively enrolled from June 2012 to October 2021 and categorized into T2DM and non-T2DM groups. Clinical characteristics, cardiac function, and myocardial fibrosis evaluated by CMR were compared between the two groups. The primary endpoint included both all-cause mortality and heart transplantation. Cause of mortality was classified into heart failure death, sudden cardiac death, and non-cardiac death. Cox regression analysis and Kaplan-Meier analysis were performed to identify the association between T2DM and clinical outcomes. Propensity score matching (PSM) cohort including 438 patients was analyzed to reduce the bias from confounding covariates.
Among the 1152 included DCM patients, 155 (13%) patients had T2DM. Patients with T2DM were older (55 ± 12 vs. 47 ± 14 years, P < 0.001), had higher New York Heart Association (NYHA) functional class (P = 0.003), higher prevalence of hypertension (37% vs. 21%, P < 0.001), atrial fibrillation (31% vs. 16%, P < 0.001), lower left ventricular (LV) ejection fraction (EF) (23 ± 9% vs. 27 ± 12%, P < 0.001), higher late gadolinium enhancement (LGE) presence (55% vs. 45%, P = 0.02), and significantly elevated native T1 (1323 ± 81ms vs. 1305 ± 73ms, P = 0.01) and extracellular volume fraction (ECV) (32.7 ± 6.3% vs. 31.3 ± 5.9%, P = 0.01) values. After a median follow-up of 38 months (interquartile range: 20-57 months), 239 patients reached primary endpoint. Kaplan-Meier analysis showed that patients with T2DM had worse clinical outcomes compared with those without T2DM in the overall cohort (annual events rate: 10.2% vs. 5.7%, P < 0.001). T2DM was independently associated with an increased risk of primary endpoint in the overall (Hazard ratio [HR]: 1.61, 95% CI: 1.13-2.33, P = 0.01) and PSM (HR: 1.54, 95% CI: 1.05-2.24, P = 0.02) cohorts. Furthermore, T2DM was associated with a higher risk of heart failure death (P = 0.006) and non-cardiac death (P = 0.02), but not sudden cardiac death (P = 0.16).
Patients with T2DM represented a more severe clinical profile and experienced more adverse outcomes compared to those without T2DM in a large DCM cohort.
Trial registration number: ChiCTR1800017058; URL: https://www.
gov .
2 型糖尿病（T2DM）与非缺血性扩张型心肌病（DCM）并存对临床特征、心肌纤维化和结局的影响仍不完全清楚。
从 2012 年 6 月至 2021 年 10 月，前瞻性纳入了 1152 例非缺血性 DCM 患者，并分为 T2DM 和非 T2DM 组。比较两组患者的临床特征、心脏功能和 CMR 评估的心肌纤维化。主要终点包括全因死亡率和心脏移植。死亡原因分为心力衰竭死亡、心源性猝死和非心源性死亡。采用 Cox 回归分析和 Kaplan-Meier 分析确定 T2DM 与临床结局之间的关系。包括 438 例患者的倾向评分匹配（PSM）队列用于减少混杂因素的偏倚。
在纳入的 1152 例 DCM 患者中，155 例（13%）患者患有 T2DM。与非 T2DM 患者相比，T2DM 患者年龄更大（55±12 岁比 47±14 岁，P<0.001），纽约心脏协会（NYHA）功能分级更高（P=0.003），高血压患病率更高（37%比 21%，P<0.001），心房颤动发生率更高（31%比 16%，P<0.001），左心室（LV）射血分数（EF）更低（23±9%比 27±12%，P<0.001），晚期钆增强（LGE）存在率更高（55%比 45%，P=0.02），自然 T1 值（1323±81ms 比 1305±73ms，P=0.01）和细胞外容积分数（ECV）（32.7±6.3%比 31.3±5.9%，P=0.01）更高。中位随访 38 个月（四分位距：20-57 个月）后，239 例患者达到主要终点。Kaplan-Meier 分析显示，与非 T2DM 患者相比，T2DM 患者在整个队列中的临床结局更差（年事件发生率：10.2%比 5.7%，P<0.001）。T2DM 与总体（危险比[HR]：1.61，95%置信区间：1.13-2.33，P=0.01）和 PSM（HR：1.54，95%置信区间：1.05-2.24，P=0.02）队列中的主要终点风险增加独立相关。此外，T2DM 与心力衰竭死亡（P=0.006）和非心源性死亡（P=0.02）的风险增加相关，但与心源性猝死（P=0.16）无关。
在大型 DCM 队列中，与非 T2DM 患者相比，T2DM 患者的临床特征更严重，结局更差。
试验注册编号：ChiCTR1800017058；网址：https://www.chictr.org.cn/。
注册号：NCT04054664。
