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Abstract：
BACKGROUND: The adverse prognostic impact of diabetes on hypertrophic cardiomyopathy (HCM) is poorly understood. We sought to explore the underlying mechanisms in terms of structural and functional remodelling in HCM patients with coexisting diabetes (HCM-DM).
METHODS: A total of 45 HCM-DM patients were retrospectively included. Isolated HCM controls (HCM patients without diabetes) were matched to HCM-DM patients in terms of maximal wall thickness, age, and gender distribution. Left ventricular (LV) and atrial (LA) performance were evaluated using cardiac magnetic resonance feature tracking strain analyses. The associations between diabetes and LV/LA impairment were investigated by univariable and multivariable linear regression.
RESULTS: Compared with the isolated HCM controls, the HCM-DM patients had smaller end-diastolic volume and stroke volume, lower ejection fraction, larger mass/volume ratio and impaired strains in all three directions (all P < 0.05). In terms of the LA parameters, HCM-DM patients presented impaired LA reservoir and conduit strain/strain rate (all P < 0.05). Among all HCM patients, comorbidity with diabetes was independently associated with a low LV ejection fraction (β = - 6.05, P < 0.001) and impaired global longitudinal strain (β = 1.40, P = 0.007). Moreover, compared with the isolated HCM controls, HCM-DM patients presented with more myocardial fibrosis according to late gadolinium enhancement, which was an independent predictor of impaired LV global radial strain (β = - 45.81, P = 0.008), LV global circumferential strain (β = 18.25, P = 0.003), LA reservoir strain (β = - 59.20, P < 0.001) and strain rate (β = - 2.90, P = 0.002).
CONCLUSIONS: Diabetes has adverse effects on LV and LA function in HCM patients, which may be important contributors to severe manifestations and outcomes in those patients. The present study strengthened the evidence of the prevention and management of diabetes in HCM patients.
METHODS: A total of 45 HCM-DM patients were retrospectively included. Isolated HCM controls (HCM patients without diabetes) were matched to HCM-DM patients in terms of maximal wall thickness, age, and gender distribution. Left ventricular (LV) and atrial (LA) performance were evaluated using cardiac magnetic resonance feature tracking strain analyses. The associations between diabetes and LV/LA impairment were investigated by univariable and multivariable linear regression.
RESULTS: Compared with the isolated HCM controls, the HCM-DM patients had smaller end-diastolic volume and stroke volume, lower ejection fraction, larger mass/volume ratio and impaired strains in all three directions (all P < 0.05). In terms of the LA parameters, HCM-DM patients presented impaired LA reservoir and conduit strain/strain rate (all P < 0.05). Among all HCM patients, comorbidity with diabetes was independently associated with a low LV ejection fraction (β = - 6.05, P < 0.001) and impaired global longitudinal strain (β = 1.40, P = 0.007). Moreover, compared with the isolated HCM controls, HCM-DM patients presented with more myocardial fibrosis according to late gadolinium enhancement, which was an independent predictor of impaired LV global radial strain (β = - 45.81, P = 0.008), LV global circumferential strain (β = 18.25, P = 0.003), LA reservoir strain (β = - 59.20, P < 0.001) and strain rate (β = - 2.90, P = 0.002).
CONCLUSIONS: Diabetes has adverse effects on LV and LA function in HCM patients, which may be important contributors to severe manifestations and outcomes in those patients. The present study strengthened the evidence of the prevention and management of diabetes in HCM patients.
摘要：
背景：人们对糖尿病对肥厚型心肌病（HCM）的不良预后影响知之甚少。我们试图探索共存糖尿病（HCM-DM）的HCM患者的结构和功能重塑方面的潜在机制。
方法：回顾性纳入45例HCM-DM患者。就最大壁厚而言，孤立的HCM对照（无糖尿病的HCM患者）与HCM-DM患者相匹配，年龄,和性别分布。使用心脏磁共振特征跟踪应变分析评估左心室（LV）和心房（LA）性能。通过单变量和多变量线性回归研究糖尿病与LV/LA损害之间的关联。
结果：与分离的HCM对照相比，HCM-DM患者的舒张末期容积和中风量较小，降低射血分数,较大的质量/体积比和受损的菌株在所有三个方向（均P<0.05）。就LA参数而言，HCM-DM患者存在受损的LA储层和导管应变/应变率（均P<0.05）。在所有HCM患者中，糖尿病合并症与左心室射血分数低（β=-6.05，P<0.001）和整体纵向应变受损（β=1.40，P=0.007）独立相关。此外，与孤立的HCM对照相比，HCM-DM患者表现为更多的心肌纤维化根据晚期钆增强，这是左心室整体径向应变受损的独立预测因子(β=-45.81，P=0.008)，LV整体周向应变(β=18.25,P=0.003),LA储层应变(β=-59.20,P<0.001)和应变率(β=-2.90,P=0.002)。
结论：糖尿病对HCM患者的LV和LA功能有不良影响，这可能是这些患者的严重表现和结局的重要原因。本研究加强了HCM患者糖尿病预防和管理的证据。
方法：回顾性纳入45例HCM-DM患者。就最大壁厚而言，孤立的HCM对照（无糖尿病的HCM患者）与HCM-DM患者相匹配，年龄,和性别分布。使用心脏磁共振特征跟踪应变分析评估左心室（LV）和心房（LA）性能。通过单变量和多变量线性回归研究糖尿病与LV/LA损害之间的关联。
结果：与分离的HCM对照相比，HCM-DM患者的舒张末期容积和中风量较小，降低射血分数,较大的质量/体积比和受损的菌株在所有三个方向（均P<0.05）。就LA参数而言，HCM-DM患者存在受损的LA储层和导管应变/应变率（均P<0.05）。在所有HCM患者中，糖尿病合并症与左心室射血分数低（β=-6.05，P<0.001）和整体纵向应变受损（β=1.40，P=0.007）独立相关。此外，与孤立的HCM对照相比，HCM-DM患者表现为更多的心肌纤维化根据晚期钆增强，这是左心室整体径向应变受损的独立预测因子(β=-45.81，P=0.008)，LV整体周向应变(β=18.25,P=0.003),LA储层应变(β=-59.20,P<0.001)和应变率(β=-2.90,P=0.002)。
结论：糖尿病对HCM患者的LV和LA功能有不良影响，这可能是这些患者的严重表现和结局的重要原因。本研究加强了HCM患者糖尿病预防和管理的证据。
