糖尿病性心肌病变的超声心动图表型：ARISE-HF试验中15个月随访期内的演变
Echocardiographic phenotypes of diabetic myocardial disorder: evolution over 15 months follow-up in the ARISE-HF trial.
作者信息
Marwick Thomas H, Lam Carolyn, Liu Yuxi, Del Prato Stefano, Rosenstock Julio, Butler Javed, Ezekowitz Justin, Ibrahim Nasrien E, Tang W H Wilson, Zannad Faiez, Perfetti Riccardo, Januzzi James L
机构信息
Baker Heart and Diabetes Institute, Melbourne and Menzies Institute for Medical Research, Hobart, Australia.
Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, VIC, 3004, Australia.
出版信息
Cardiovasc Diabetol. 2025 Jan 13;24(1):16. doi: 10.1186/s12933-024-02554-y.
BACKGROUND
Diabetic myocardial disorder (DbMD, evidenced by abnormal echocardiography or cardiac biomarkers) is a form of stage B heart failure (SBHF) at high risk for progression to overt HF. SBHF is defined by abnormal LV morphology and function and/or abnormal cardiac biomarker concentrations.
OBJECTIVE
To compare the evolution of four DbMD groups based on biomarkers alone, systolic and diastolic dysfunction alone, or their combination.
METHODS
The Aldose Reductase Inhibition for Stabilization of Exercise Capacity in Heart Failure (ARISE-HF) trial was a Phase 3 randomised trial of an aldose reductase inhibitor in patients with well-controlled type 2 diabetes mellitus (T2DM). The 1858 potential participants (age 67 ± 7 years; 50% women) were screened for SBHF based on abnormal echocardiography or biomarkers (N-terminal pro-B-type natriuretic peptide ≥ 40 ng/L or high sensitivity cardiac troponin T ≥ 10 ng/L [women] and ≥ 16 ng/L [men]). Exercise capacity (peak VO) was reduced in 669 with DbMD (age 68 ± 7, 50% women), and peak VO was reassessed at 15 months.
RESULTS
The 1463 (79%) participants with DbMD were allocated to four clusters; 907 (49%) showed isolated elevation of cardiac biomarkers, 301 (16%) with systolic dysfunction/hypertrophy, 162 (9%) with diastolic dysfunction and 93 (5%) comprised an overlap cluster (combined diastolic, systolic or LV geometric abnormalities). Reduced VO (< 75% predicted) was present in 669 (46%); 72% of those with both systolic and diastolic dysfunction, 56% of those with systolic dysfunction and LVH, 53% of those with diastolic dysfunction and 38% with biomarkers alone (p < 0.0001). In 669 patients followed over 15 months, there was a similar small decrement in VO in all groups.
CONCLUSIONS
Among individuals with T2DM and SBHF, reduced functional capacity is most prevalent in those with multiple physiological disturbances. However, there was no difference between phenogroups in the evolution of exercise intolerance.
TRIAL REGISTRATION
ARISE-HF, NCT04083339.
背景
糖尿病性心肌病变（DbMD，通过超声心动图或心脏生物标志物异常得以证实）是B期心力衰竭（SBHF）的一种形式，具有进展为显性心力衰竭的高风险。SBHF由左心室形态和功能异常和/或心脏生物标志物浓度异常定义。
目的
比较仅基于生物标志物、仅基于收缩和舒张功能障碍或两者结合的四个DbMD组的演变情况。
方法
心力衰竭运动能力稳定的醛糖还原酶抑制试验（ARISE-HF）是一项在控制良好的2型糖尿病（T2DM）患者中进行的醛糖还原酶抑制剂3期随机试验。根据超声心动图异常或生物标志物（N末端B型利钠肽原≥40 ng/L或高敏心肌肌钙蛋白T≥10 ng/L[女性]和≥16 ng/L[男性]）对1858名潜在参与者（年龄67±7岁；50%为女性）进行SBHF筛查。669名患有DbMD的患者（年龄68±7岁，50%为女性）运动能力（峰值VO）降低，并在15个月时重新评估峰值VO。
结果
1463名（79%）患有DbMD的参与者被分为四个组；907名（49%）仅表现为心脏生物标志物升高，301名（16%）患有收缩功能障碍/肥厚，162名（9%）患有舒张功能障碍，93名（5%）为重叠组（合并舒张、收缩或左心室几何形状异常）。669名（46%）患者VO降低（<预测值的75%）；收缩和舒张功能障碍患者中有72%，收缩功能障碍和左心室肥厚患者中有56%，舒张功能障碍患者中有53%，仅生物标志物异常患者中有38%（p<0.0001）。在对669名患者进行15个月的随访中，所有组的VO均有类似的小幅下降。
结论
在2型糖尿病和SBHF患者中，功能能力下降在存在多种生理紊乱的患者中最为普遍。然而，各表型组在运动不耐受的演变方面没有差异。
试验注册
ARISE-HF，NCT04083339。
Zotero 插件