Department of Radiology, Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
Laboratory of Cardiovascular Diseases, Regenerative Medicine Research Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
Cardiovasc Diabetol. 2024 Oct 23;23(1):375. doi: 10.1186/s12933-024-02472-z.
Hypertension (HTN) and diabetes mellitus (DM) are two common comorbidities of heart failure with reduced ejection fraction (HFrEF), each of which can cause right ventricular (RV) dysfunction. The aim of this study was to investigate the impact of DM on RV dysfunction and ventricular interdependence in hypertensive HFrEF patients via cardiac magnetic resonance imaging (MRI) feature tracking.
This study included 249 patients with HFrEF: 77 HFrEF controls, 97 with hypertensive HFrEF (HTN-HFrEF [DM-]) and 75 with hypertensive HFrEF and comorbid DM (HTN-HFrEF [DM+]). The cardiac MRI-derived biventricular global radial (GRS), circumferential (GCS) and longitudinal (GLS) peak strains were obtained and compared among the groups. Multivariable linear regression and mediation analyses were used to evaluate the effects of DM and left ventricular (LV) strain on RV strain.
The biventricular GLS and GLS of segments 8, 9 and 14 of the interventricular septum (IVS) decreased gradually from the HFrEF control group to the HTN-HFrEF (DM-) group to the HTN-HFrEF (DM+) group (all P < 0.05). Patients with DM had even lower biventricular GCS and IVS strains in all directions in specific segments than did those without DM and the HFrEF controls (all P < 0.05). DM was independently associated with impaired RVGLS and RVGCS (both P < 0.05) in hypertensive HFrEF patients. The difference in RVGLS between the hypertensive HFrEF subgroups was partly mediated by LVGLS [β = 0.80, 95% CI (0.39-1.31)], and that of RVGCS was partly mediated by LVGCS [β = 0.28, 95% CI (0.01-0.62)].
In hypertensive HFrEF patients, comorbid DM may have aggravated RV dysfunction and was an independent determinant of impaired RV strain. RV dysfunction might be directly affected by DM and partially mediated by LV strain through unfavorable ventricular independence.
高血压（HTN）和糖尿病（DM）是射血分数降低的心力衰竭（HFrEF）的两种常见合并症，两者均可导致右心室（RV）功能障碍。本研究旨在通过心脏磁共振成像（MRI）特征追踪来研究 DM 对高血压伴 HFrEF 患者 RV 功能障碍和心室相互依赖性的影响。
本研究纳入 249 例 HFrEF 患者：77 例 HFrEF 对照组、97 例高血压伴 HFrEF（HTN-HFrEF [DM-]）和 75 例高血压伴 HFrEF 合并 DM（HTN-HFrEF [DM+]）。获得心脏 MRI 衍生的双心室整体径向（GRS）、圆周（GCS）和纵向（GLS）峰值应变，并在各组间进行比较。采用多变量线性回归和中介分析来评估 DM 和左心室（LV）应变对 RV 应变的影响。
双心室 GLS 和间隔 8、9 和 14 节段的 GLS 从 HFrEF 对照组逐渐降低至 HTN-HFrEF（DM-）组，再降低至 HTN-HFrEF（DM+）组（均 P<0.05）。有 DM 的患者在所有方向上的双心室 GCS 和特定节段的 IVS 应变均低于无 DM 的患者和 HFrEF 对照组（均 P<0.05）。DM 与高血压伴 HFrEF 患者的 RVGLS 和 RVGCS 受损独立相关（均 P<0.05）。高血压伴 HFrEF 亚组之间 RVGLS 的差异部分由 LVGLS 介导[β=0.80，95%CI（0.39-1.31）]，RVGCS 的差异部分由 LVGCS 介导[β=0.28，95%CI（0.01-0.62）]。
在高血压伴 HFrEF 患者中，合并 DM 可能加重 RV 功能障碍，是 RV 应变受损的独立决定因素。RV 功能障碍可能直接受到 DM 的影响，并通过不利的心室独立性部分由 LV 应变介导。
