Yu Shi-Qin, Shi Ke, Li Yuan, Wang Jin, Gao Yue, Shi Rui, Yan Wei-Feng, Xu Hua-Yan, Guo Ying-Kun, Yang Zhi-Gang
Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, China.
Department of Radiology, Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China.
Cardiovasc Diabetol. 2024 Aug 8;23(1):293. doi: 10.1186/s12933-024-02384-y.
The adverse prognostic impact of diabetes on hypertrophic cardiomyopathy (HCM) is poorly understood. We sought to explore the underlying mechanisms in terms of structural and functional remodelling in HCM patients with coexisting diabetes (HCM-DM).
A total of 45 HCM-DM patients were retrospectively included. Isolated HCM controls (HCM patients without diabetes) were matched to HCM-DM patients in terms of maximal wall thickness, age, and gender distribution. Left ventricular (LV) and atrial (LA) performance were evaluated using cardiac magnetic resonance feature tracking strain analyses. The associations between diabetes and LV/LA impairment were investigated by univariable and multivariable linear regression.
Compared with the isolated HCM controls, the HCM-DM patients had smaller end-diastolic volume and stroke volume, lower ejection fraction, larger mass/volume ratio and impaired strains in all three directions (all P < 0.05). In terms of the LA parameters, HCM-DM patients presented impaired LA reservoir and conduit strain/strain rate (all P < 0.05). Among all HCM patients, comorbidity with diabetes was independently associated with a low LV ejection fraction (β = - 6.05, P < 0.001) and impaired global longitudinal strain (β = 1.40, P = 0.007). Moreover, compared with the isolated HCM controls, HCM-DM patients presented with more myocardial fibrosis according to late gadolinium enhancement, which was an independent predictor of impaired LV global radial strain (β = - 45.81, P = 0.008), LV global circumferential strain (β = 18.25, P = 0.003), LA reservoir strain (β = - 59.20, P < 0.001) and strain rate (β = - 2.90, P = 0.002).
Diabetes has adverse effects on LV and LA function in HCM patients, which may be important contributors to severe manifestations and outcomes in those patients. The present study strengthened the evidence of the prevention and management of diabetes in HCM patients.
糖尿病对肥厚型心肌病（HCM）不良预后的影响尚不清楚。我们试图从合并糖尿病的HCM患者（HCM-DM）的结构和功能重塑方面探索其潜在机制。
回顾性纳入45例HCM-DM患者。孤立性HCM对照组（无糖尿病的HCM患者）在最大室壁厚度、年龄和性别分布方面与HCM-DM患者进行匹配。使用心脏磁共振特征追踪应变分析评估左心室（LV）和心房（LA）功能。通过单变量和多变量线性回归研究糖尿病与LV/LA功能损害之间的关联。
与孤立性HCM对照组相比，HCM-DM患者的舒张末期容积和每搏输出量较小，射血分数较低，质量/容积比更大，且三个方向的应变均受损（均P<0.05）。就LA参数而言，HCM-DM患者的LA储存和管道应变/应变率受损（均P<0.05）。在所有HCM患者中，合并糖尿病与低LV射血分数（β=-6.05，P<0.001）和整体纵向应变受损（β=1.40，P=0.007）独立相关。此外，与孤立性HCM对照组相比，根据延迟钆增强，HCM-DM患者的心肌纤维化更多，这是LV整体径向应变受损（β=-45.81，P=0.008）、LV整体圆周应变（β=18.25，P=0.003）、LA储存应变（β=-59.20，P<0.001）和应变率（β=-2.90，P=0.002）的独立预测因素。
糖尿病对HCM患者的LV和LA功能有不良影响，这可能是这些患者出现严重临床表现和预后的重要因素。本研究加强了HCM患者糖尿病预防和管理的证据。
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