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Abstract：
BACKGROUND: Diabetic peripheral neuropathy (DPN) is the most prevalent complication of diabetes, and has been demonstrated to be independently associated with cardiovascular events and mortality. This aim of this study was to investigate the subclinical left ventricular (LV) myocardial dysfunction in type 2 diabetes mellitus (T2DM) patients with and without DPN.
METHODS: One hundred and thirty T2DM patients without DPN, 61 patients with DPN and 65 age and sex-matched controls who underwent cardiovascular magnetic resonance (CMR) imaging were included, all subjects had no symptoms of heart failure and LV ejection fraction ≥ 50%. LV myocardial non-infarct late gadolinium enhancement (LGE) was determined. LV global strains, including radial, circumferential and longitudinal peak strain (PS) and peak systolic and diastolic strain rates (PSSR and PDSR, respectively), were evaluated using CMR feature tracking and compared among the three groups. Multivariable linear regression analyses were performed to determine the independent factors of reduced LV global myocardial strains in T2DM patients.
RESULTS: The prevalence of non-infarct LGE was higher in patients with DPN than those without DPN (37.7% vs. 19.2%, p = 0.008). The LV radial and longitudinal PS (radial: 36.60 ± 7.24% vs. 33.57 ± 7.30% vs. 30.72 ± 8.68%; longitudinal: - 15.03 ± 2.52% vs. - 13.39 ± 2.48% vs. - 11.89 ± 3.02%), as well as longitudinal PDSR [0.89 (0.76, 1.05) 1/s vs. 0.80 (0.71, 0.93) 1/s vs. 0.77 (0.63, 0.87) 1/s] were decreased significantly from controls through T2DM patients without DPN to patients with DPN (all p < 0.001). LV radial and circumferential PDSR, as well as circumferential PS were reduced in both patient groups (all p < 0.05), but were not different between the two groups (all p > 0.05). Radial and longitudinal PSSR were decreased in patients with DPN (p = 0.006 and 0.003, respectively) but preserved in those without DPN (all p > 0.05). Multivariable linear regression analyses adjusting for confounders demonstrated that DPN was independently associated with LV radial and longitudinal PS (β = - 3.025 and 1.187, p = 0.014 and 0.003, respectively) and PDSR (β = 0.283 and - 0.086, p = 0.016 and 0.001, respectively), as well as radial PSSR (β = - 0.266, p = 0.007).
CONCLUSIONS: There was more severe subclinical LV dysfunction in T2DM patients complicated with DPN than those without DPN, suggesting further prospective study with more active intervention in this cohort of patients.
METHODS: One hundred and thirty T2DM patients without DPN, 61 patients with DPN and 65 age and sex-matched controls who underwent cardiovascular magnetic resonance (CMR) imaging were included, all subjects had no symptoms of heart failure and LV ejection fraction ≥ 50%. LV myocardial non-infarct late gadolinium enhancement (LGE) was determined. LV global strains, including radial, circumferential and longitudinal peak strain (PS) and peak systolic and diastolic strain rates (PSSR and PDSR, respectively), were evaluated using CMR feature tracking and compared among the three groups. Multivariable linear regression analyses were performed to determine the independent factors of reduced LV global myocardial strains in T2DM patients.
RESULTS: The prevalence of non-infarct LGE was higher in patients with DPN than those without DPN (37.7% vs. 19.2%, p = 0.008). The LV radial and longitudinal PS (radial: 36.60 ± 7.24% vs. 33.57 ± 7.30% vs. 30.72 ± 8.68%; longitudinal: - 15.03 ± 2.52% vs. - 13.39 ± 2.48% vs. - 11.89 ± 3.02%), as well as longitudinal PDSR [0.89 (0.76, 1.05) 1/s vs. 0.80 (0.71, 0.93) 1/s vs. 0.77 (0.63, 0.87) 1/s] were decreased significantly from controls through T2DM patients without DPN to patients with DPN (all p < 0.001). LV radial and circumferential PDSR, as well as circumferential PS were reduced in both patient groups (all p < 0.05), but were not different between the two groups (all p > 0.05). Radial and longitudinal PSSR were decreased in patients with DPN (p = 0.006 and 0.003, respectively) but preserved in those without DPN (all p > 0.05). Multivariable linear regression analyses adjusting for confounders demonstrated that DPN was independently associated with LV radial and longitudinal PS (β = - 3.025 and 1.187, p = 0.014 and 0.003, respectively) and PDSR (β = 0.283 and - 0.086, p = 0.016 and 0.001, respectively), as well as radial PSSR (β = - 0.266, p = 0.007).
CONCLUSIONS: There was more severe subclinical LV dysfunction in T2DM patients complicated with DPN than those without DPN, suggesting further prospective study with more active intervention in this cohort of patients.
摘要：
背景：糖尿病周围神经病变（DPN）是糖尿病最常见的并发症，并且已被证明与心血管事件和死亡率独立相关.这项研究的目的是研究有和没有DPN的2型糖尿病（T2DM）患者的亚临床左心室（LV）心肌功能障碍。
方法：一百三十例无DPN的T2DM患者，纳入61例DPN患者和65例年龄和性别匹配的对照者，他们接受了心血管磁共振（CMR）成像，所有受试者均无心力衰竭症状,且LV射血分数≥50%.确定LV心肌非梗死晚期钆增强(LGE)。LV全球菌株，包括径向，周向和纵向峰值应变(PS)以及收缩期和舒张期峰值应变率(PSSR和PDSR，分别)，使用CMR特征跟踪进行评估，并在三组之间进行比较。进行多变量线性回归分析以确定T2DM患者左心室整体心肌应变降低的独立因素。
结果：DPN患者的非梗死性LGE患病率高于无DPN患者（37.7%vs.19.2%,p=0.008)。左心室径向和纵向PS(径向：36.60±7.24%vs.33.57±7.30%vs.30.72±8.68%；纵向：-15.03±2.52%vs.-13.39±2.48%vs.-11.89±3.02%)，以及纵向PDSR[0.89（0.76，1.05）1/svs.0.80（0.71，0.93）1/svs.从对照组到无DPN的T2DM患者到有DPN的患者，0.77（0.63，0.87）1/s]显着降低（所有p<0.001）。LV径向和周向PDSR,两组患者的周向PS均降低（均p<0.05），但两组间差异无统计学意义(均P>0.05)。DPN患者的径向和纵向PSSR降低（分别为p=0.006和0.003），而无DPN患者则保留（均p>0.05）。校正混杂因素的多变量线性回归分析表明，DPN与左心室径向和纵向PS（分别为β=-3.025和1.187，p=0.014和0.003）和PDSR（分别为β=0.283和-0.086，p=0.016和0.001）独立相关。以及径向PSSR(β=-0.266，p=0.007)。
结论：T2DM合并DPN患者的亚临床LV功能障碍比无DPN患者严重，建议在该队列患者中进行更积极的干预，进一步进行前瞻性研究。
方法：一百三十例无DPN的T2DM患者，纳入61例DPN患者和65例年龄和性别匹配的对照者，他们接受了心血管磁共振（CMR）成像，所有受试者均无心力衰竭症状,且LV射血分数≥50%.确定LV心肌非梗死晚期钆增强(LGE)。LV全球菌株，包括径向，周向和纵向峰值应变(PS)以及收缩期和舒张期峰值应变率(PSSR和PDSR，分别)，使用CMR特征跟踪进行评估，并在三组之间进行比较。进行多变量线性回归分析以确定T2DM患者左心室整体心肌应变降低的独立因素。
结果：DPN患者的非梗死性LGE患病率高于无DPN患者（37.7%vs.19.2%,p=0.008)。左心室径向和纵向PS(径向：36.60±7.24%vs.33.57±7.30%vs.30.72±8.68%；纵向：-15.03±2.52%vs.-13.39±2.48%vs.-11.89±3.02%)，以及纵向PDSR[0.89（0.76，1.05）1/svs.0.80（0.71，0.93）1/svs.从对照组到无DPN的T2DM患者到有DPN的患者，0.77（0.63，0.87）1/s]显着降低（所有p<0.001）。LV径向和周向PDSR,两组患者的周向PS均降低（均p<0.05），但两组间差异无统计学意义(均P>0.05)。DPN患者的径向和纵向PSSR降低（分别为p=0.006和0.003），而无DPN患者则保留（均p>0.05）。校正混杂因素的多变量线性回归分析表明，DPN与左心室径向和纵向PS（分别为β=-3.025和1.187，p=0.014和0.003）和PDSR（分别为β=0.283和-0.086，p=0.016和0.001）独立相关。以及径向PSSR(β=-0.266，p=0.007)。
结论：T2DM合并DPN患者的亚临床LV功能障碍比无DPN患者严重，建议在该队列患者中进行更积极的干预，进一步进行前瞻性研究。
