背景:移植前2型糖尿病(T2DM)与心脏移植(HT)后心血管和全因死亡率增加有关,但这种关联的根本原因仍不清楚.这项研究的目的是使用心血管磁共振成像检查T2DM对心脏移植后左心室(LV)心肌变形和心肌灌注的影响。
方法:我们调查了31例移植前T2DM[HT(DM)]的HT受体,34名无移植前T2DM[HT(DM-)]的HT受体和36名对照。LV心肌菌株,包括全球纵向,径向,和周向应变(GLS,GRS和GCS,分别),进行组间计算和比较,静息心肌灌注指数,其中包括到达心肌信号强度峰值的时间(TTM),最大信号强度(MaxSI),和上坡。通过Spearman分析确定LV应变参数或灌注指数与生化指标之间的关系。使用多变量线性回归分析和反向逐步选择来评估T2DM对HT接受者中LV菌株的影响。
结果:在HT(DM)组中,LVGLS,GRS,和GCS的幅度明显低于HT(DM-)和对照组。HT(DM+)组TTM高于HT(DM-)组和对照组,而上坡和MaxSI组间没有观察到显著差异。糖化血红蛋白与菌株的大小呈负相关(纵向,r=-0.399;径向,r=-0.362;周向,r=-0.389)(均P<0.05),与TTM呈正相关(r=0.485,P<0.001)。包括移植前T2DM和灌注指数的回归分析显示,移植前T2DM,而不是灌注指数,是LV应变的独立决定因素(β=纵向,-0.508;径向,-0.370;圆周,-0.371)(均P<0.05)。
结论:在心脏移植受者中,移植前T2DM对亚临床左心室收缩功能有不利影响,并可能影响HT后的心肌微循环.
BACKGROUND: Pretransplant type 2 diabetes mellitus (T2DM) is associated with increased cardiovascular and all-cause mortality after heart transplant (HT), but the underlying causes of this association remain unclear. The purpose of this research was to examine the impact of T2DM on left ventricular (LV) myocardial deformation and myocardial perfusion following heart transplantation using cardiovascular magnetic resonance imaging.
METHODS: We investigated thirty-one HT recipients with pretransplant T2DM [HT(DM+)], thirty-four HT recipients without pretransplant T2DM [HT(DM-)] and thirty-six controls. LV myocardial strains, including the global longitudinal, radial, and circumferential strain (GLS, GRS and GCS, respectively), were calculated and compared among groups, as were resting myocardial perfusion indices, which included time to peak myocardial signal intensity (TTM), maximum signal intensity (MaxSI), and Upslope. The relationships between LV strain parameters or perfusion indices and biochemical indicators were determined through Spearman\'s analysis. The impact of T2DM on LV strains in HT recipients was assessed using multivariable linear regression analyses with backward stepwise selection.
RESULTS: In the HT(DM+) group, the LV GLS, GRS, and GCS exhibited significantly lower magnitudes than those in both the HT(DM-) and control groups. TTM was higher in the HT(DM+) group than in both the HT(DM-) and control groups, while no significant differences were observed among the groups regarding Upslope and MaxSI. There was a negative correlation between glycated hemoglobin and the magnitude of strains (longitudinal, r = - 0.399; radial, r = - 0.362; circumferential, r = - 0.389) (all P < 0.05), and a positive correlation with TTM (r = 0.485, P < 0.001). Regression analyses that included both pretransplant T2DM and perfusion indices revealed that pretransplant T2DM, rather than perfusion indices, was an independent determinant of LV strain (β = longitudinal, - 0.508; radial, - 0.370; circumferential, - 0.371) (all P < 0.05).
CONCLUSIONS: In heart transplant recipients, pretransplant T2DM has a detrimental effect on subclinical left ventricular systolic function and could potentially impact myocardial microcirculation following HT.