背景:舒张功能障碍和心脏几何结构改变是糖尿病性心肌病的早期指标。然而,葡萄糖连续体的心脏变化与心外膜脂肪组织(EAT)对这些变化的贡献之间的关联尚未得到研究.
目的:在本研究中,我们的目的是使用心脏磁共振成像(CMRI)研究EAT对糖尿病连续体心脏舒张功能和结构改变的影响.
方法:我们招募了根据糖耐量状态分组的个体。使用超声心动图和CMRI评估左心室结构和舒张功能以确定EAT,心肌内脂肪,和相关参数。还使用多变量逻辑回归模型。
结果:在一项针对370名患者的研究中(209名正常糖耐量,82糖尿病前期,79糖尿病),糖尿病前期和糖尿病患者表现出心脏尺寸增加和舒张功能障碍,包括E/E'(二尖瓣早期流入速度与二尖瓣环早期舒张速度之比)(7.9±0.51vs.8.5±0.64vs.10.0±0.93,p=0.010),左心房容积指数(28.21±14.7vs.33.2±12.8vs.37.4±8.2mL/m2,p<0.001),和左心室峰值充盈率(4.46±1.75vs.3.61±1.55vs.3.20±1.30mL/s,p<0.001)。糖尿病前期和糖尿病患者的EAT显着增加(26.3±1.16vs.31.3±1.83vs.33.9±1.9gm,p=0.001),而心肌内脂肪没有显著差异。糖尿病前期改变了心脏几何形状,但不是舒张功能(OR1.22[1.02-1.83],p=0.012;和1.70[0.79-3.68],p=0.135)。糖尿病显著影响心脏结构和舒张功能(OR1.42[1.11-1.97],p=0.032;和2.56[1.03-5.40],p=0.034)在调整协变量后。
结论:糖尿病前期患者的EAT升高与心脏结构和舒张功能的不良改变有关,可能是糖尿病性心肌病早期发病的潜在机制。
BACKGROUND: Diastolic dysfunction and alterations in cardiac geometry are early indicators of diabetic cardiomyopathy. However, the association between cardiac changes across the glucose continuum and the contribution of epicardial adipose tissue (EAT) to these changes has not yet been investigated.
OBJECTIVE: In this study, we aim to investigated the EAT on cardiac diastolic function and structural alterations along the diabetic continuum using cardiac magnetic resonance imaging (CMRI).
METHODS: We enrolled individuals who were categorized into groups based on glucose tolerance status. Left ventricular structure and diastolic function were assessed using echocardiography and CMRI to determine the EAT, intramyocardial fat, and associated parameters. Multivariable logistic regression models were also used.
RESULTS: In a study of 370 patients (209 normal glucose tolerance, 82 prediabetes, 79 diabetes), those with prediabetes and diabetes showed increased heart dimensions and diastolic dysfunction, including E/E\' (the ratio of early mitral inflow velocity to mitral annular early diastolic velocity) (7.9±0.51 vs. 8.5±0.64 vs. 10.0±0.93, p=0.010), left atrial volume index (28.21±14.7 vs. 33.2±12.8 vs. 37.4±8.2 mL/m2, p<0.001), and left ventricular peak filling rate (4.46±1.75 vs. 3.61±1.55 vs. 3.20±1.30 mL/s, p<0.001). EAT significantly increased in prediabetes and diabetes (26.3±1.16 vs. 31.3±1.83 vs. 33.9±1.9 gm, p=0.001), while intramyocardial fat did not differ significantly. Prediabetes altered heart geometry, but not diastolic function (OR 1.22 [1.02-1.83], p=0.012; and 1.70 [0.79-3.68], p=0.135). Diabetes significantly affected both heart structure and diastolic function (OR 1.42 [1.11-1.97], p=0.032; and 2.56 [1.03-5.40], p=0.034) after adjusting for covariates.
CONCLUSIONS: Elevated EAT was observed in patients with prediabetes and is associated with adverse alterations in cardiac structure and diastolic function, potentially serving as an underlying mechanism for the early onset of diabetic cardiomyopathy.