医学
心脏病学
内科学
射血分数
临床终点
糖尿病性心肌病
2型糖尿病
糖化血红素
心肌纤维化
2型糖尿病
心力衰竭
心肌病
糖尿病
临床试验
内分泌学
作者
Hongkai Zhang,Yu Du,Ce Shi,Nan Zhang,Hui‐Qiang Gao,Yongliang Zhong,Maozhou Wang,Zhen Zhou,Xuelian Gao,Shuang Li,Lin Yang,Tong Liu,Zhanming Fan,Zhonghua Sun,Lei Xu
摘要
Poorly controlled type 2 diabetes mellitus (T2DM) is known to result in left ventricular (LV) dysfunction, myocardial fibrosis, and ischemic/nonischemic dilated cardiomyopathy (ICM/NIDCM). However, less is known about the prognostic value of T2DM on LV longitudinal function and late gadolinium enhancement (LGE) assessed with cardiac MRI in ICM/NIDCM patients.To measure LV longitudinal function and myocardial scar in ICM/NIDCM patients with T2DM and to determine their prognostic values.Retrospective cohort.Two hundred thirty-five ICM/NIDCM patients (158 with T2DM and 77 without T2DM).3T; steady-state free precession cine; phase-sensitive inversion recovery segmented gradient echo LGE sequences.Global peak longitudinal systolic strain rate (GLPSSR) was evaluated to LV longitudinal function with feature tracking. The predictive value of GLPSSR was determined with ROC curve. Glycated hemoglobin (HbA1c) was measured. The primary adverse cardiovascular endpoint was follow up every 3 months.Mann-Whitney U test or student's t-test; Intra and inter-observer variabilities; Kaplan-Meier method; Cox proportional hazards analysis (threshold = 5%).ICM/NIDCM patients with T2DM exhibited significantly lower absolute value of GLPSSR (0.39 ± 0.14 vs. 0.49 ± 0.18) and higher proportion of LGE positive (+) despite similar LV ejection fraction, compared to without T2DM. LV GLPSSR was able to predict primary endpoint (AUC 0.73) and optimal cutoff point was 0.4. ICM/NIDCM patients with T2DM (GLPSSR < 0.4) had more markedly impaired survival. Importantly, this group (GLPSSR < 0.4, HbA1c ≥ 7.8%, or LGE (+)) exhibited the worst survival. In multivariate analysis, GLPSSR, HbA1c, and LGE (+) significantly predicted primary adverse cardiovascular endpoint in overall ICM/NIDCM and ICM/NIDCM patients with T2DM.T2DM has an additive deleterious effect on LV longitudinal function and myocardial fibrosis in ICM/NIDCM patients. Combining GLPSSR, HbA1c, and LGE could be promising markers in predicting outcomes in ICM/NIDCM patients with T2DM.3 TECHNICAL EFFICACY: 5.
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