Gong Mingxia, Xu Min, Pan Suoya, Jiang Xiaohong
Department of Echocardiography of The Third Affiliated Hospital of Soochow University, Chang Zhou City, Jiangsu Province, China.
Department of Cardiology of The Third Affiliated Hospital of Soochow University, Chang Zhou City, Jiangsu Province, China.
BMC Cardiovasc Disord. 2025 Jun 7;25(1):436. doi: 10.1186/s12872-025-04900-8.
To quantitatively assess the alterations in left atrial morphology and function in patients with asymptomatic type 2 diabetes mellitus (T2DM) via 4D-Auto Left Atrial Quantification analysis (4D Auto LAQ), investigate their correlation with diabetic nephropathy (DN), and evaluate the predictive value for major adverse cardiovascular event (MACE).
A cohort of 449 asymptomatic T2DM patients was categorized into four groups: those without DN(G0) and those with DN, which was further subdivided into stages G1, G2, and G3. Through 4D-Auto LAQ analysis, we quantified the left atrial (LA) volume as well as the longitudinal and circumferential strains during the reservoir, conduit, and contraction phases. Additionally, we investigated the association between LA volume, strain parameters, and glomerular filtration rate (GFR). Among the participants, 190 patients in the DN group were followed up. The primary endpoint for follow-up was defined as the first occurrence of non-fatal acute myocardial infarction, stroke, congestive heart failure, or cardiac death.
(1) Analysis of variance indicated no statistically significant differences in echocardiographic data for left ventricular size or function across groups. (2) Correlation analysis after multivariable adjustment revealed that the LA minimal volume index (LAVImin) increased with the progression of DN, while the absolute value of the LA strain index(reservoir and conduit period) decreased as renal damage worsened, exhibiting a highly significant correlation with the GFR (P < 0.01). (3) Univariate and multivariate Cox regression analyses revealed that: LAVmin, LASr, GFR, and HbA1c were associated with MACEs in patients with DN. Incorporating LAVmin and LASr into the basic model significantly enhanced the predictive value for MACEs in DN patients (with an area under the curve (AUC) of 0.818, sensitivity of 78.6%, specificity of 85.4%).
The increase in LA volume and weakened reservoir and conduit function in T2DM patients dynamically reflect the severity of renal damage. LAVImin and LASr are associated with the occurrence of MACEs in asymptomatic type 2 diabetes patients with early renal damage.
Not applicable.
通过4D自动左心房定量分析（4D Auto LAQ）定量评估无症状2型糖尿病（T2DM）患者左心房形态和功能的改变，研究其与糖尿病肾病（DN）的相关性，并评估其对主要不良心血管事件（MACE）的预测价值。
将449例无症状T2DM患者分为四组：无DN组（G0）和DN组，DN组再进一步分为G1、G2和G3期。通过4D Auto LAQ分析，我们量化了左心房（LA）容积以及储存期、管道期和收缩期的纵向和圆周应变。此外，我们研究了LA容积、应变参数与肾小球滤过率（GFR）之间的关联。在参与者中，对DN组的190例患者进行了随访。随访的主要终点定义为首次发生非致命性急性心肌梗死、中风、充血性心力衰竭或心源性死亡。
（1）方差分析表明，各组左心室大小或功能的超声心动图数据无统计学显著差异。（2）多变量调整后的相关性分析显示，LA最小容积指数（LAVImin）随DN进展而增加，而LA应变指数（储存期和管道期）的绝对值随肾损伤加重而降低，与GFR呈高度显著相关性（P < 0.01）。（3）单因素和多因素Cox回归分析显示：LAVmin、LASr、GFR和HbA1c与DN患者的MACE相关。将LAVmin和LASr纳入基本模型显著提高了DN患者MACE的预测价值（曲线下面积（AUC）为0.818，敏感性为78.6%，特异性为85.4%）。
T2DM患者LA容积增加以及储存和管道功能减弱动态反映了肾损伤的严重程度。LAVImin和LASr与早期肾损伤的无症状2型糖尿病患者MACE的发生相关。
不适用。
