Impact of Diabetes Mellitus on Left Ventricular Mechanics and Long-Term Outcome in Patients with Hypertrophic Cardiomyopathy

IF 1.6 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques Pub Date : 2024-12-11 DOI:10.1111/echo.70048

Hala Mahfouz Badran, John Anis Helmy, Nagalaa Fahem Ahmed, Magdi Yacoub

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Abstract

Background

Type 2 diabetes mellitus (T2DM) intensifies the clinical symptoms of heart diseases and leads to a worse prognosis in heart failure patients. Although hypertrophic cardiomyopathy (HCM) and DM rarely co-occur, particularly in older individuals, the impact of DM on cardiac function and outcomes in individuals with HCM remains insufficiently understood.

Methods

A total of 421 HCM patients were included and followed up in a prospective cohort study (mean 68.7 months). In the diabetic HCM group (n = 47), patients had a mean age of 47 ± 17 years, and 31 (66%) were male, while the non-diabetic HCM group (n = 374) had a mean age of 44 ± 14 years, and 246 (65%) were male. At study entry, all patients underwent echocardiographic evaluation, encompassing left ventricular (LV) regional and global longitudinal strain (GLS), as well as strain rate (SR) analysis.

Results

In diabetic HCM, there was a greater prevalence of hypertension (p < 0.0001), while the ratio of septal to posterior wall thickness (PWT) (p < 0.003) and E' value were lower (p < 0.009) compared to non-diabetic HCM. No significant difference between groups in NYHA class or cardiac phenotype. Diabetic HCM exhibited notable reductions in GLS (p < 0.02), systolic SR (SRsys) (p < 0.04), and early diastolic SR (SRe) p < 0.006. Additionally, there was a significant inverse correlation between LVGLS and HbA1c levels (r = −0.58, p < 0.0001), and the duration of diabetes (r = −0.39, p < 0.006). Hospitalization rates were greater in the diabetic HCM than in the non-diabetic group (44.7% vs.19.5%, p < 0.001). Among all demographic characteristics, phenotypic data, conventional echocardiographic measurements, and LV mechanics, diabetes emerged as the sole determinant of hospitalization among HCM patients. The presence of diabetes nearly tripled the odds of hospitalization (odds ratio: 2.813 [1.448–5.465], p < 0.002). However, diabetes did not negatively affect long-term survival, and age remained the only independent predictor of all-cause mortality.

Conclusions

In HCM, T2DM is linked to more deterioration of cardiac mechanics and contributes to unfavorable consequences by frequent hospitalization on its own, independent of age, comorbidities, or phenotype.

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糖尿病对肥厚性心肌病患者左心室力学和远期预后的影响。

背景：2型糖尿病（T2DM）加重心衰患者的临床症状，导致预后较差。虽然肥厚性心肌病（HCM）和糖尿病很少同时发生，特别是在老年人中，但糖尿病对HCM患者心功能和预后的影响仍未充分了解。方法：在一项前瞻性队列研究中，共纳入421例HCM患者，随访时间平均为68.7个月。糖尿病HCM组患者47例，平均年龄47±17岁，男性31例（66%）；非糖尿病HCM组患者374例，平均年龄44±14岁，男性246例（65%）。在研究开始时，所有患者接受超声心动图评估，包括左心室（LV）区域和全局纵向应变（GLS）以及应变率（SR）分析。结果：糖尿病型HCM中高血压的发生率高于非糖尿病型HCM (p < 0.0001)，而室间隔/后壁厚度（PWT）比（p < 0.003）和E′值均低于非糖尿病型HCM （p < 0.009）。各组间NYHA类别及心脏表型无显著差异。糖尿病HCM患者GLS （p < 0.02）、收缩期SR (SRsys) （p < 0.04）和早期舒张期SR （SRe）均显著降低（p < 0.006）。此外，LVGLS与HbA1c水平（r = -0.58, p < 0.0001）和糖尿病病程（r = -0.39, p < 0.006）呈显著负相关。糖尿病HCM组的住院率高于非糖尿病组（44.7%比19.5%,p < 0.001）。在所有人口统计学特征、表型数据、常规超声心动图测量和左室力学中，糖尿病成为HCM患者住院的唯一决定因素。糖尿病患者住院的几率几乎增加了两倍（优势比：2.813 [1.448-5.465],p < 0.002）。然而，糖尿病对长期生存没有负面影响，年龄仍然是全因死亡率的唯一独立预测因子。结论：在HCM中，T2DM与更多的心脏力学恶化有关，并且由于频繁住院而导致不良后果，与年龄、合并症或表型无关。

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来源期刊

Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques 医学-心血管系统

CiteScore

2.40

自引率

6.70%

发文量

211

审稿时长

3-6 weeks

期刊介绍： Echocardiography: A Journal of Cardiovascular Ultrasound and Allied Techniques is the official publication of the International Society of Cardiovascular Ultrasound. Widely recognized for its comprehensive peer-reviewed articles, case studies, original research, and reviews by international authors. Echocardiography keeps its readership of echocardiographers, ultrasound specialists, and cardiologists well informed of the latest developments in the field.