2型糖尿病合并或不合并阻塞性冠状动脉疾病患者右心室功能与临床结局的比较：一项心脏磁共振成像研究的见解

Comparison of right ventricular function and clinical outcomes in type 2 diabetes patients with and without obstructive coronary artery disease: insights from a CMR study.

作者信息

Wang Jin, Yan Wei-Feng, Shi Ke, Xu Hua-Yan, Yu Shi-Qin, Guo Ying-Kun, Jiang Li, Gao Yue, Li Xue-Ming, Li Yuan, Yang Zhi-Gang

机构信息

Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, China.

Department of Radiology, Key Laboratory of Obstetric and Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, West China Second University Hospital, Sichuan University, 20# Section 3, Renmin South Road, Chengdu, 610041, Sichuan, China.

出版信息

Cardiovasc Diabetol. 2025 May 26;24(1):229. doi: 10.1186/s12933-025-02755-z.

DOI:10.1186/s12933-025-02755-z

PMID:40420082

Abstract

BACKGROUND

Obstructive coronary artery disease (OCAD) marks a high-risk group within patients with type 2 diabetes mellitus (T2DM), underscoring the need for tailored prevention and management strategies. However, limited data exist on right ventricular (RV) function and clinical outcomes in T2DM patients with versus without OCAD. This study aimed to investigate the differences in RV function and clinical outcomes between these two groups.

METHODS

The study included 246 T2DM patients {141 patients without OCAD [T2DM(OCAD-)] and 105 with [T2DM(OCAD+)]} and 85 control subjects. Cardiovascular magnetic resonance were utilized to assess RV structure, function, and global myocardial strain [including peak strain (PS), peak systolic (PSSR) and diastolic strain rate (PDSR) in longitudinal, circumferential, and radial directions]. The endpoints, which included all-cause mortality, heart failure hospitalization, and overall composite outcome, were evaluated over a median follow-up period of 5.7 (3.1, 6.7) years. We used linear regression to identify determinants of impaired RV myocardial strain and Cox proportional hazards models to evaluate their associations with clinical outcomes.

RESULTS

RV global circumferential PS (GCPS), longitudinal PS (GLPS) and PSSR (PSSR-L) decreased progressively from control subjects to T2DM(OCAD-) patients, and further to T2DM(OCAD+) patients (all P < 0.05). The presence of OCAD was significantly correlated with impaired GRPS (β = - 0.186), GCPS (β = - 0.121), GLPS (β = - 0.153), PSSR-L (β = - 0.165), and PDSR-R (β = - 0.133) in the context of T2DM. Multivariable Cox regression analysis identified OCAD as an independent predictor of future endpoints, with T2DM (OCAD+) patients showing a 1.91-fold increased risk compared to T2DM (OCAD-) patients (hazard ratio: 1.91; 95% confidence interval: 1.06-3.44; P = 0.031).

CONCLUSIONS

T2DM patients with OCAD showed distinct RV functional impairments and worse long-term outcomes compared to those without OCAD, including more severe RV systolic and diastolic dysfunction and a significantly higher risk of adverse clinical outcomes.

摘要

背景

阻塞性冠状动脉疾病（OCAD）是2型糖尿病（T2DM）患者中的高危群体，这突出了制定针对性预防和管理策略的必要性。然而，关于合并与未合并OCAD的T2DM患者的右心室（RV）功能及临床结局的数据有限。本研究旨在调查这两组患者RV功能及临床结局的差异。

方法

该研究纳入了246例T2DM患者{141例无OCAD的患者[T2DM（OCAD-）]和105例有OCAD的患者[T2DM（OCAD+）]}以及85例对照者。采用心血管磁共振评估RV结构、功能及整体心肌应变[包括纵向、圆周和径向的峰值应变（PS）、收缩期峰值（PSSR）和舒张期应变率（PDSR）]。在中位随访期5.7（3.1，6.7）年期间评估包括全因死亡率、心力衰竭住院率和总体复合结局在内的终点事件。我们使用线性回归确定RV心肌应变受损的决定因素，并使用Cox比例风险模型评估它们与临床结局的关联。

结果

从对照者到T2DM（OCAD-）患者，再到T2DM（OCAD+）患者，RV整体圆周PS（GCPS）、纵向PS（GLPS）和PSSR（PSSR-L）逐渐降低（所有P<0.05）。在T2DM背景下，OCAD的存在与GRPS（β=-0.186）、GCPS（β=-0.121）、GLPS（β=-0.153）、PSSR-L（β=-0.165）和PDSR-R（β=-0.133）受损显著相关。多变量Cox回归分析确定OCAD是未来终点事件的独立预测因素，与T2DM（OCAD-）患者相比，T2DM（OCAD+）患者的风险增加了1.91倍（风险比：1.91；95%置信区间：1.06-3.44；P=0.031）。