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Empagliflozin and left atrial function in patients with type 2 diabetes mellitus and coronary artery disease: insight from the EMPA-HEART CardioLink-6 randomized clinical trial. 恩格列净与2型糖尿病合并冠心病患者的左心房功能:EMPA-HEART CardioLink-6随机临床试验的启示。
IF 8.5 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-08-28 DOI: 10.1186/s12933-024-02344-6
Marina Pourafkari, Kim A Connelly, Subodh Verma, C David Mazer, Hwee Teoh, Adrian Quan, Shaun G Goodman, Archana Rai, Ming Yen Ng, Djeven P Deva, Piero Triverio, Laura Jiminez-Juan, Andrew T Yan, Yin Ge

Background: Sodium-glucose cotransporter-2 (SGLT2) inhibitors have demonstrated reduction in heart failure outcomes in patients with type 2 diabetes mellitus, although the exact mechanism of benefit remains unclear. Alteration in left atrial (LA) function due to chronic pressure or volume overload is a hallmark of heart failure.

Objective: To evaluate the effect of the SGLT2 inhibitor empagliflozin on LA volume and function.

Methods: 90 patients with coronary artery disease and type 2 diabetes (T2DM) were randomized to empagliflozin (n = 44) or placebo (n = 46), and underwent cardiac magnetic resonance (CMR) imaging at baseline and after 6 months. The main outcome was change in LA volume; LA function, including active and passive components, was also measured by a blinded reader.

Results: At baseline, there was no significant difference in LA volumes between the empagliflozin (indexed maximum LA volume 26.4 ± 8.4mL/m2, minimum LA volume 11.1 ± 5.7mL/m2) and placebo (indexed maximum LA volume 28.7 ± 8.2mL/m2, minimum LA volume 12.6 ± 5.0mL/m2) groups. After 6 months, changes in LA volumes did not differ with adjusted difference (empagliflozin minus placebo): 0.99 mL/m2 (95% CI: -1.7 to 3.7 mL/m2; p = 0.47) for indexed maximum LA volume, and 0.87 mL/m2 (95% CI: -0.9 to 2.6 mL/m2; p = 0.32) for indexed minimum LA volume. Changes in total LA emptying fraction were also similar, with between-group adjusted mean difference - 0.01 (95% CI: -0.05 to 0.03, p = 0.59).

Conclusion: SGLT2 inhibition with empagliflozin for 6 months did not have a significant impact on LA volume and function in patients with T2DM and coronary artery disease. (Effects of Empagliflozin on Cardiac Structure in Patients with Type 2 Diabetes [EMPA-HEART]; NCT02998970).

背景:钠-葡萄糖共转运体-2(SGLT2)抑制剂已证明可减少2型糖尿病患者的心衰预后,但确切的获益机制仍不清楚。慢性压力或容量超负荷导致的左心房(LA)功能改变是心力衰竭的特征之一:方法:90 名患有冠状动脉疾病和 2 型糖尿病(T2DM)的患者被随机分配到恩格列净(44 人)或安慰剂(46 人)中,并在基线和 6 个月后接受心脏磁共振(CMR)成像。主要结果是LA容积的变化;LA功能(包括主动和被动部分)也由盲人进行测量:基线时,恩格列净组(指数化最大LA容积为26.4±8.4mL/m2,最小LA容积为11.1±5.7mL/m2)和安慰剂组(指数化最大LA容积为28.7±8.2mL/m2,最小LA容积为12.6±5.0mL/m2)的LA容积无明显差异。6个月后,LA容积的变化与调整后的差异(empagliflozin减去安慰剂)不存在差异:指数化最大 LA 容量为 0.99 mL/m2 (95% CI: -1.7 to 3.7 mL/m2; p = 0.47),指数化最小 LA 容量为 0.87 mL/m2 (95% CI: -0.9 to 2.6 mL/m2; p = 0.32)。LA总排空分数的变化也相似,组间调整后平均差为-0.01(95% CI:-0.05至0.03,P = 0.59):结论:在T2DM和冠心病患者中,持续6个月的恩格列净SGLT2抑制剂不会对LA容量和功能产生显著影响。(Empagliflozin对2型糖尿病患者心脏结构的影响[EMPA-HEART];NCT02998970)。
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引用次数: 0
Additive effect of metabolic dysfunction-associated fatty liver disease on left ventricular function and global strain in type 2 diabetes mellitus patients: a 3.0 T cardiac magnetic resonance feature tracking study. 代谢功能障碍相关脂肪肝对 2 型糖尿病患者左心室功能和整体应变的叠加效应:3.0 T 心脏磁共振特征追踪研究。
IF 8.5 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-08-27 DOI: 10.1186/s12933-024-02410-z
Xin Tang, Rui Shi, Li Jiang, Wei-Feng Yan, Pei-Lun Han, Wen-Lei Qian, Zhi-Gang Yang, Yuan Li

Background: Type 2 diabetes mellitus (T2DM) and metabolic-associated fatty liver disease (MAFLD) are both metabolic disorders that negatively impact the cardiovascular system. This study comprehensively analyzed the additive effect of MAFLD on left ventricular function and global strain in T2DM patients by cardiac magnetic resonance (CMR).

Methods: Data of 261 T2DM patients, including 109 with and 152 without MAFLD, as well as 73 matched normal controls from our medical center between June 2015 and March 2022 were retrospectively analyzed. CMR-derived parameters, including LV function and global strain parameters, were compared among different groups. Univariate and multivariate linear regression analyses were conducted to investigate the impact of various factors on LV function and global strain.

Results: Our investigation revealed a progressive deterioration in LV functional parameters across three groups: control subjects, T2DM patients without MAFLD, and T2DM patients with MAFLD. Statistically significant increases in left ventricular end-diastolic volume index (LVEDVI), left ventricular end-systolic volume index (LVESVI), left ventricular mass index (LVMI) were observed, along with decreases in left ventricular ejection fraction (LVEF) and left ventricular global function index (LVGFI). Among these three groups, significant reductions were also noted in the absolute values of LV global radial, circumferential, and longitudinal peak strains (GRPS, GCPS, and GLPS), as well as in peak systolic (PSSR) and peak diastolic strain rates (PDSR). MAFLD was identified as an independent predictor of LVEF, LVMI, LVGFI, GRPS, GCPS, and GLPS in multivariate linear analysis. Besides, the incidence of late gadolinium enhancement was higher in MAFLD patients than in non-MAFLD patients (50/109 [45.9%] vs. 42/152 [27.6%], p = 0.003). Furthermore, escalating MAFLD severity was associated with a numerical deterioration in both LV function parameters and global strain values.

Conclusions: This study thoroughly compared CMR parameters in T2DM patients with and without MAFLD, uncovering MAFLD's adverse impact on LV function and deformation in T2DM patients. These findings highlight the critical need for early detection and comprehensive management of cardiac function in T2DM patients with MAFLD.

背景:2型糖尿病(T2DM)和代谢相关性脂肪肝(MAFLD)都是对心血管系统有负面影响的代谢性疾病。本研究通过心脏磁共振(CMR)全面分析了 MAFLD 对 T2DM 患者左心室功能和整体应变的叠加效应:回顾性分析本医疗中心2015年6月至2022年3月期间261例T2DM患者(包括109例MAFLD患者和152例无MAFLD患者)以及73例匹配正常对照组的数据。比较了不同组间的 CMR 衍生参数,包括左心室功能和整体应变参数。通过单变量和多变量线性回归分析,研究各种因素对左心室功能和整体应变的影响:结果:我们的研究发现,在对照组、无 MAFLD 的 T2DM 患者和有 MAFLD 的 T2DM 患者三组中,左心室功能参数呈进行性恶化。据统计,左心室舒张末期容积指数(LVEDVI)、左心室收缩末期容积指数(LVESVI)和左心室质量指数(LVMI)均有明显增加,而左心室射血分数(LVEF)和左心室整体功能指数(LVGFI)则有所下降。在这三类患者中,左心室整体径向、环向和纵向峰值应变(GRPS、GCPS 和 GLPS)的绝对值以及收缩期峰值应变率(PSSR)和舒张期峰值应变率(PDSR)也明显下降。在多变量线性分析中,MAFLD 被确定为 LVEF、LVMI、LVGFI、GRPS、GCPS 和 GLPS 的独立预测因子。此外,MAFLD 患者晚期钆增强的发生率高于非 MAFLD 患者(50/109 [45.9%] vs. 42/152 [27.6%],P = 0.003)。此外,MAFLD严重程度的增加与左心室功能参数和整体应变值的数值恶化有关:这项研究全面比较了患有和不患有 MAFLD 的 T2DM 患者的 CMR 参数,揭示了 MAFLD 对 T2DM 患者左心室功能和变形的不利影响。这些发现强调了早期检测和全面管理患有 MAFLD 的 T2DM 患者心脏功能的迫切需要。
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引用次数: 0
Identifying metabotypes of insulin resistance severity in children with metabolic syndrome. 确定代谢综合征儿童胰岛素抵抗严重程度的代谢类型。
IF 8.5 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-08-27 DOI: 10.1186/s12933-024-02412-x
Álvaro González-Domínguez, Jesús Domínguez-Riscart, Otto Savolainen, Alfonso Lechuga-Sancho, Rikard Landberg, Raúl González-Domínguez

Background: Insulin resistance is a frequent precursor of typical obesity and metabolic syndrome complications. However, accurate diagnosis remains elusive because of its pathophysiological complexity and heterogeneity. Herein, we have explored the utility of insulin secretion dynamics in response to an oral glucose tolerance test as a surrogate marker to identify distinct metabotypes of disease severity.

Methods: The study population consisted of children with obesity and insulin resistance, stratified according to the post-challenge insulin peak timing (i.e., early, middle, and late peak), from whom fasting and postprandial plasma and erythrocytes were collected for metabolomics analysis.

Results: Children with late insulin peak manifested worse cardiometabolic health (i.e., higher blood pressure, glycemia, and HOMA-IR scores) than early responders. These subjects also showed more pronounced changes in metabolites mirroring failures in energy homeostasis, oxidative stress, metabolism of cholesterol and phospholipids, and adherence to unhealthy dietary habits. Furthermore, delayed insulin peak was associated with impaired metabolic flexibility, as reflected in compromised capacity to regulate mitochondrial energy pathways and the antioxidant defense in response to glucose overload.

Conclusions: Altogether, these findings suggest that insulin resistance could encompass several phenotypic subtypes characterized by graded disturbances in distinctive metabolic derangements occurring in childhood obesity, which serve as severity predictive markers.

背景:胰岛素抵抗是典型肥胖症和代谢综合征并发症的常见前兆。然而,由于其病理生理学的复杂性和异质性,准确诊断仍然难以捉摸。在此,我们探索了胰岛素分泌动态对口服葡萄糖耐量试验的反应作为替代标记物的效用,以确定疾病严重程度的不同代谢类型:研究对象包括患有肥胖症和胰岛素抵抗的儿童,根据挑战后胰岛素峰值时间(即早期、中期和晚期峰值)进行分层,收集他们的空腹和餐后血浆及红细胞进行代谢组学分析:结果:与早期反应者相比,胰岛素峰值晚期的儿童心脏代谢健康状况更差(即血压、血糖和 HOMA-IR 评分更高)。这些受试者的代谢物也出现了更明显的变化,反映了能量平衡、氧化应激、胆固醇和磷脂代谢以及不健康饮食习惯的失败。此外,胰岛素峰值延迟与代谢灵活性受损有关,这反映在调节线粒体能量途径和抗氧化防御以应对葡萄糖超载的能力受损:总之,这些研究结果表明,胰岛素抵抗可包括几种表型亚型,其特点是儿童肥胖症中出现的独特代谢紊乱分级紊乱,可作为严重程度的预测标志物。
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引用次数: 0
Adiposity modifies the association between heart failure risk and glucose metabolic disorder in older individuals: a community-based prospective cohort study. 肥胖会改变老年人心力衰竭风险与葡萄糖代谢紊乱之间的关系:一项基于社区的前瞻性队列研究。
IF 8.5 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-08-27 DOI: 10.1186/s12933-024-02418-5
Liming Hou, Xin Wang, Peilin Li, Hua Zhang, Yanli Yao, Zhendong Liu, Juan Wang, Weike Liu

Background: Glucose metabolic disorder is associated with the risk of heart failure (HF). Adiposity is a comorbidity that is inextricably linked with abnormal glucose metabolism in older individuals. However, the effect of adiposity on the association between glucose metabolic disorder and HF risk, and the underlying mechanism remain unclear.

Methods: A total of 13,251 participants aged ≥ 60 years from a cohort study were categorized into euglycemia, prediabetes, uncontrolled diabetes, and well-controlled diabetes. Adiposity was assessed using body mass index (BMI), waist-to-hip ratio (WHR), and visceral fat area (VFA). Adiposity-associated metabolic activities were evaluated using adiponectin-to-leptin ratio (ALR), homeostatic model assessment of insulin resistance (HOMA-IR), and triglyceride-glucose index (TyG). The first occurrence of HF served as the outcome during the follow-up period.

Results: A total of 1,138 participants developed HF over the course of an average follow-up period of 10.9 years. The rate of incident HF occurrence was higher in prediabetes, uncontrolled diabetes, and well-controlled diabetes participants compared to that in euglycemia participants. However, the high rates were significantly attenuated by BMI, VFA, and WHR. For WHR in particular, the hazard ratio for incident HF was 1.18 (95% confidence interval (CI): 1.03, 1.35, Padj.=0.017) in prediabetes, 1.59 (95% CI: 1.34, 1.90, Padj.<0.001) in uncontrolled diabetes, and 1.10 (95% CI: 0.85, 1.43, Padj.=0.466) in well-controlled diabetes. The population attributable risk percentage for central obesity classified by WHR for incident HF was 30.3% in euglycemia, 50.0% in prediabetes, 48.5% in uncontrolled diabetes, and 54.4% in well-controlled diabetes. Adiposity measures, especially WHR, showed a significant interaction with glucose metabolic disorder in incident HF (all Padj.<0.001). ALR was negatively associated and HOMA-IR and TyG were positively associated with BMI, WHR, VFA, and incident HF (all Padj.<0.05). ALR, HOMA-IR, and TyG mediated the associations for BMI, WHR and VFA with incident HF (all Padj.<0.05).

Conclusions: Adiposity attenuated the association of glucose metabolic disorder with incident HF. The results also showed that WHR may be an appropriate indicator for evaluating adiposity in older individuals. Adiposity-associated metabolic activities may have a bridging role in the process of adiposity attenuating the association between glucose metabolic disorder and incident HF.

Trial registration: retrospectively registered number: ChiCTR-EOC-17,013,598.

背景:糖代谢紊乱与心力衰竭(HF)风险有关。肥胖是一种与老年人糖代谢异常密不可分的合并症。然而,脂肪对糖代谢紊乱与心力衰竭风险之间关系的影响及其内在机制仍不清楚:方法:将一项队列研究中 13251 名年龄≥ 60 岁的参与者分为优生、糖尿病前期、糖尿病未控制和糖尿病控制良好四类。通过体重指数(BMI)、腰臀比(WHR)和内脏脂肪面积(VFA)来评估肥胖程度。脂肪相关代谢活动通过脂肪连素与瘦素比值(ALR)、胰岛素抵抗稳态模型评估(HOMA-IR)和甘油三酯-葡萄糖指数(TyG)进行评估。在随访期间,以首次出现高血压作为结果:结果:在平均 10.9 年的随访期内,共有 1 138 名参与者患上了心房颤动。与优生优育者相比,糖尿病前期、糖尿病未控制和糖尿病控制良好者的心房颤动发生率更高。然而,体重指数(BMI)、血管内皮脂肪含量(VFA)和体重指数(WHR)会明显降低高发率。特别是WHR,在糖尿病前期,发生高血压的危险比为1.18(95% 置信区间(CI):1.03, 1.35, Padj.=0.017),在糖尿病控制良好的人群中,发生高血压的危险比为1.59(95% CI:1.34, 1.90, Padj.adj.=0.466)。以 WHR 分类的中心性肥胖对高血脂事件的人群可归因风险百分比在优血症中为 30.3%,在糖尿病前期为 50.0%,在未控制的糖尿病中为 48.5%,在控制良好的糖尿病中为 54.4%。脂肪测量指标,尤其是 WHR,与发生 HF 的糖代谢紊乱有显著的交互作用(全部为 Padj.adj.adj.结论:脂肪减少了葡萄糖代谢紊乱与心房颤动的关联。研究结果还表明,WHR 可能是评估老年人肥胖程度的适当指标。与脂肪相关的代谢活动可能在脂肪减少葡萄糖代谢紊乱与心房颤动之间的关联过程中起到桥梁作用:ChiCTR-EOC-17,013,598.
{"title":"Adiposity modifies the association between heart failure risk and glucose metabolic disorder in older individuals: a community-based prospective cohort study.","authors":"Liming Hou, Xin Wang, Peilin Li, Hua Zhang, Yanli Yao, Zhendong Liu, Juan Wang, Weike Liu","doi":"10.1186/s12933-024-02418-5","DOIUrl":"10.1186/s12933-024-02418-5","url":null,"abstract":"<p><strong>Background: </strong>Glucose metabolic disorder is associated with the risk of heart failure (HF). Adiposity is a comorbidity that is inextricably linked with abnormal glucose metabolism in older individuals. However, the effect of adiposity on the association between glucose metabolic disorder and HF risk, and the underlying mechanism remain unclear.</p><p><strong>Methods: </strong>A total of 13,251 participants aged ≥ 60 years from a cohort study were categorized into euglycemia, prediabetes, uncontrolled diabetes, and well-controlled diabetes. Adiposity was assessed using body mass index (BMI), waist-to-hip ratio (WHR), and visceral fat area (VFA). Adiposity-associated metabolic activities were evaluated using adiponectin-to-leptin ratio (ALR), homeostatic model assessment of insulin resistance (HOMA-IR), and triglyceride-glucose index (TyG). The first occurrence of HF served as the outcome during the follow-up period.</p><p><strong>Results: </strong>A total of 1,138 participants developed HF over the course of an average follow-up period of 10.9 years. The rate of incident HF occurrence was higher in prediabetes, uncontrolled diabetes, and well-controlled diabetes participants compared to that in euglycemia participants. However, the high rates were significantly attenuated by BMI, VFA, and WHR. For WHR in particular, the hazard ratio for incident HF was 1.18 (95% confidence interval (CI): 1.03, 1.35, P<sub>adj.</sub>=0.017) in prediabetes, 1.59 (95% CI: 1.34, 1.90, P<sub>adj.</sub><0.001) in uncontrolled diabetes, and 1.10 (95% CI: 0.85, 1.43, P<sub>adj.</sub>=0.466) in well-controlled diabetes. The population attributable risk percentage for central obesity classified by WHR for incident HF was 30.3% in euglycemia, 50.0% in prediabetes, 48.5% in uncontrolled diabetes, and 54.4% in well-controlled diabetes. Adiposity measures, especially WHR, showed a significant interaction with glucose metabolic disorder in incident HF (all P<sub>adj.</sub><0.001). ALR was negatively associated and HOMA-IR and TyG were positively associated with BMI, WHR, VFA, and incident HF (all P<sub>adj.</sub><0.05). ALR, HOMA-IR, and TyG mediated the associations for BMI, WHR and VFA with incident HF (all P<sub>adj</sub>.<0.05).</p><p><strong>Conclusions: </strong>Adiposity attenuated the association of glucose metabolic disorder with incident HF. The results also showed that WHR may be an appropriate indicator for evaluating adiposity in older individuals. Adiposity-associated metabolic activities may have a bridging role in the process of adiposity attenuating the association between glucose metabolic disorder and incident HF.</p><p><strong>Trial registration: </strong>retrospectively registered number: ChiCTR-EOC-17,013,598.</p>","PeriodicalId":9374,"journal":{"name":"Cardiovascular Diabetology","volume":null,"pages":null},"PeriodicalIF":8.5,"publicationDate":"2024-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11350974/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142079217","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Prognostic effect of the TyG index on patients with severe aortic stenosis following transcatheter aortic valve replacement: a retrospective cohort study. 经导管主动脉瓣置换术后,TyG 指数对重度主动脉瓣狭窄患者的预后影响:一项回顾性队列研究。
IF 8.5 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-08-24 DOI: 10.1186/s12933-024-02414-9
Weiya Li, Hongde Li, Shiqin Peng, Junli Li, Yuan Feng, Yong Peng, Jiafu Wei, Zhengang Zhao, Tianyuan Xiong, Haoran Yang, Chengxiang Song, Lin Bai, Yijun Yao, Fei Chen, Yue Yin, Mao Chen

Background: The triglyceride glucose (TyG) index, as a reliable marker of insulin resistance, is associated with the incidence and poor prognosis of various cardiovascular diseases. However, the relationship between the TyG index and clinical outcomes in patients with severe aortic stenosis (AS) who underwent transcatheter aortic valve replacement (TAVR) remains unclear.

Methods: This study consecutively enrolled 1569 patients with AS underwent TAVR at West China Hospital of Sichuan University between April 2014 and August 2023. The outcomes of interest included all-cause mortality, cardiovascular mortality, and major adverse cardiovascular events (MACE). Multivariate adjusted Cox regression and restricted cubic splines (RCS) regression analyses were used to assess the associations between the TyG index and the clinical outcomes. The incremental prognostic value of the TyG index was further assessed by the time-dependent Harrell's C-index, integrated discrimination improvement (IDI) and the net reclassification improvement (NRI).

Results: During a median follow-up of 1.09 years, there were 146, 70, and 196 patients experienced all-cause death, cardiovascular death, and MACE, respectively. After fully adjusting for confounders, a per-unit increase of TyG index was associated with a 441% (adjusted HR: 5.41, 95% CI: 4.01-7.32), 385% (adjusted HR: 4.85, 95% CI: 3.16-7.43), and 347% (adjusted HR: 4.47, 95% CI: 3.42-5.85) higher risk of all-cause mortality, cardiovascular mortality and MACE, respectively. The RCS regression analyses revealed a linear association between TyG index and endpoints (all P for non-linearity > 0.05) with 8.40 as the optimal binary cutoff point. Furthermore, adding TyG index to the basic risk model provided a significant incremental value in predicting poor prognosis (Time-dependent Harrell's C-index increased for all the endpoints; All-cause mortality, IDI: 0.11, P < 0.001; NRI: 0.32, P < 0.001; Cardiovascular mortality, IDI: 0.043, P < 0.001; NRI: 0.37, P < 0.001; MACE, IDI: 0.092, P < 0.001; NRI: 0.32, P < 0.001).

Conclusions: In patients with severe AS receiving TAVR, there was a positive linear relationship between TyG index and poor prognosis, with 8.4 as the optimal bivariate cutoff value. Our findings suggest TyG index holds potential value for risk stratification and guiding therapeutic decisions in patients after TAVR.

背景:甘油三酯葡萄糖(TyG)指数是胰岛素抵抗的可靠标志,与各种心血管疾病的发病率和不良预后有关。然而,在接受经导管主动脉瓣置换术(TAVR)的重度主动脉瓣狭窄(AS)患者中,TyG指数与临床预后之间的关系仍不明确:本研究连续纳入了2014年4月至2023年8月期间在四川大学华西医院接受TAVR治疗的1569例重度主动脉瓣狭窄患者。研究结果包括全因死亡率、心血管死亡率和主要不良心血管事件(MACE)。多变量调整 Cox 回归和限制性立方样条(RCS)回归分析用于评估 TyG 指数与临床结果之间的关联。TyG指数的增量预后价值通过与时间相关的Harrell's C指数、综合分辨改进(IDI)和净再分类改进(NRI)进一步评估:在中位 1.09 年的随访期间,分别有 146、70 和 196 名患者经历了全因死亡、心血管死亡和 MACE。在完全调整混杂因素后,TyG指数每增加一个单位,全因死亡、心血管死亡和MACE的风险分别增加441%(调整后HR:5.41,95% CI:4.01-7.32)、385%(调整后HR:4.85,95% CI:3.16-7.43)和347%(调整后HR:4.47,95% CI:3.42-5.85)。RCS回归分析显示,TyG指数与终点之间存在线性关系(非线性P均大于0.05),8.40为最佳二元截断点。此外,在基本风险模型中加入TyG指数可显著增加预测不良预后的价值(所有终点的时间依赖性Harrell's C指数增加;全因死亡率,IDI:0.11,P 结论:TyG指数是预测不良预后的重要指标:在接受 TAVR 的重度 AS 患者中,TyG 指数与不良预后呈正线性关系,8.4 为最佳双变量临界值。我们的研究结果表明,TyG指数对TAVR术后患者的风险分层和治疗决策具有潜在的指导价值。
{"title":"Prognostic effect of the TyG index on patients with severe aortic stenosis following transcatheter aortic valve replacement: a retrospective cohort study.","authors":"Weiya Li, Hongde Li, Shiqin Peng, Junli Li, Yuan Feng, Yong Peng, Jiafu Wei, Zhengang Zhao, Tianyuan Xiong, Haoran Yang, Chengxiang Song, Lin Bai, Yijun Yao, Fei Chen, Yue Yin, Mao Chen","doi":"10.1186/s12933-024-02414-9","DOIUrl":"10.1186/s12933-024-02414-9","url":null,"abstract":"<p><strong>Background: </strong>The triglyceride glucose (TyG) index, as a reliable marker of insulin resistance, is associated with the incidence and poor prognosis of various cardiovascular diseases. However, the relationship between the TyG index and clinical outcomes in patients with severe aortic stenosis (AS) who underwent transcatheter aortic valve replacement (TAVR) remains unclear.</p><p><strong>Methods: </strong>This study consecutively enrolled 1569 patients with AS underwent TAVR at West China Hospital of Sichuan University between April 2014 and August 2023. The outcomes of interest included all-cause mortality, cardiovascular mortality, and major adverse cardiovascular events (MACE). Multivariate adjusted Cox regression and restricted cubic splines (RCS) regression analyses were used to assess the associations between the TyG index and the clinical outcomes. The incremental prognostic value of the TyG index was further assessed by the time-dependent Harrell's C-index, integrated discrimination improvement (IDI) and the net reclassification improvement (NRI).</p><p><strong>Results: </strong>During a median follow-up of 1.09 years, there were 146, 70, and 196 patients experienced all-cause death, cardiovascular death, and MACE, respectively. After fully adjusting for confounders, a per-unit increase of TyG index was associated with a 441% (adjusted HR: 5.41, 95% CI: 4.01-7.32), 385% (adjusted HR: 4.85, 95% CI: 3.16-7.43), and 347% (adjusted HR: 4.47, 95% CI: 3.42-5.85) higher risk of all-cause mortality, cardiovascular mortality and MACE, respectively. The RCS regression analyses revealed a linear association between TyG index and endpoints (all P for non-linearity > 0.05) with 8.40 as the optimal binary cutoff point. Furthermore, adding TyG index to the basic risk model provided a significant incremental value in predicting poor prognosis (Time-dependent Harrell's C-index increased for all the endpoints; All-cause mortality, IDI: 0.11, P < 0.001; NRI: 0.32, P < 0.001; Cardiovascular mortality, IDI: 0.043, P < 0.001; NRI: 0.37, P < 0.001; MACE, IDI: 0.092, P < 0.001; NRI: 0.32, P < 0.001).</p><p><strong>Conclusions: </strong>In patients with severe AS receiving TAVR, there was a positive linear relationship between TyG index and poor prognosis, with 8.4 as the optimal bivariate cutoff value. Our findings suggest TyG index holds potential value for risk stratification and guiding therapeutic decisions in patients after TAVR.</p>","PeriodicalId":9374,"journal":{"name":"Cardiovascular Diabetology","volume":null,"pages":null},"PeriodicalIF":8.5,"publicationDate":"2024-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11344917/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142055035","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Bone proteins are associated with cardiovascular risk according to the SCORE2-Diabetes algorithm. 根据 SCORE2-糖尿病算法,骨蛋白与心血管风险有关。
IF 8.5 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-08-24 DOI: 10.1186/s12933-024-02406-9
Sheila González-Salvatierra, Antonia García-Martín, Beatriz García-Fontana, Luis Martínez-Heredia, Cristina García-Fontana, Manuel Muñoz-Torres

Background: Typical bone proteins, such as sclerostin and periostin, have been associated with cardiovascular disease (CVD). Simultaneously, several risk scores have been developed to predict CVD in the general population. Therefore, we aimed to evaluate the association of these bone proteins related to CVD, with the main vascular risk scales: Framingham Risk Score (FRS), REGICOR and SCORE2-Diabetes, in patients with type 2 diabetes. We focus in particular on the SCORE2-Diabetes algorithm, which predicts 10-year CVD risk and is specific to the study population.

Methods: This was a cross-sectional study including 104 patients with type 2 diabetes (62 ± 6 years, 60% males). Clinical data, biochemical measurements, and serum bioactive sclerostin and periostin levels were collected, and different risk scales were calculated. The association between bioactive sclerostin or periostin with the risk scales was analyzed.

Results: A positive correlation was observed between circulating levels of bioactive sclerostin (p < 0.001) and periostin (p < 0.001) with SCORE2-Diabetes values. However, no correlation was found with FRS or REGICOR scales. Both serum bioactive sclerostin and periostin levels were significantly elevated in patients at high-very high risk of CVD (score ≥ 10%) than in the low-moderate risk group (score < 10%) (p < 0.001 for both). Moreover, analyzing these proteins to identify patients with type 2 diabetes at high-very high vascular risk using ROC curves, we observed significant AUC values for bioactive sclerostin (AUC = 0.696; p = 0.001), periostin (AUC = 0.749; p < 0.001), and the model combining both (AUC = 0.795; p < 0.001). For diagnosing high-very high vascular risk, serum bioactive sclerostin levels > 131 pmol/L showed 51.6% sensitivity and 78.6% specificity. Similarly, serum periostin levels > 1144 pmol/L had 64.5% sensitivity and 76.2% specificity.

Conclusions: Sclerostin and periostin are associated with vascular risk in the SCORE2-Diabetes algorithm, opening a new line of investigation to identify novel biomarkers of cardiovascular risk in the type 2 diabetes population.

背景:典型的骨蛋白(如硬骨蛋白和骨膜蛋白)与心血管疾病(CVD)有关。与此同时,还开发出了几种风险评分来预测普通人群中的心血管疾病。因此,我们的目的是评估这些与心血管疾病相关的骨蛋白与主要血管风险量表之间的关联:弗雷明汉风险评分(FRS)、REGICOR 和 SCORE2-糖尿病。我们特别关注 SCORE2-Diabetes 算法,该算法可预测 10 年心血管疾病风险,是研究人群的特有算法:这是一项横断面研究,包括 104 名 2 型糖尿病患者(62 ± 6 岁,60% 为男性)。研究收集了临床数据、生化测量结果、血清生物活性硬蛋白和包膜蛋白水平,并计算了不同的风险量表。分析了生物活性硬骨素或骨膜增生蛋白与风险量表之间的关联:结果:生物活性硬骨蛋白(p 131 pmol/L)与循环水平之间呈正相关,灵敏度为 51.6%,特异度为 78.6%。同样,血清包膜生长因子水平> 1144 pmol/L的敏感性为64.5%,特异性为76.2%:结论:在 SCORE2-Diabetes 算法中,硬骨蛋白和骨膜增生蛋白与血管风险相关,为确定 2 型糖尿病人群心血管风险的新型生物标志物开辟了一条新的研究路线。
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引用次数: 0
Pentoxifylline ameliorates subclinical atherosclerosis progression in patients with type 2 diabetes and chronic kidney disease: a randomized pilot trial. 五氧嘧啶可改善 2 型糖尿病和慢性肾病患者亚临床动脉粥样硬化的进展:一项随机试验。
IF 8.5 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-08-24 DOI: 10.1186/s12933-024-02393-x
Javier Donate-Correa, Carla M Ferri, Carmen Mora-Fernández, Nayra Pérez-Delgado, Ainhoa González-Luis, Juan F Navarro-González

Background: Diabetic kidney disease (DKD) is associated with a higher risk of cardiovascular disease (CVD). Pentoxifylline (PTF), a nonselective phosphodiesterase inhibitor with anti-inflammatory, antiproliferative, and antifibrotic actions, has demonstrated renal benefits in both clinical trials and meta-analyses. The present work aimed to study the effects of PTF on the progression of subclinical atherosclerosis (SA) in a population of patients with diabetes and moderate to severe chronic kidney disease (CKD).

Methods: In this open-label, randomized controlled, prospective single-center pilot study the evolution of carotid intima-media thickness (CIMT) and ankle-brachial index (ABI) were determined in 102 patients with type 2 diabetes mellitus and CKD assigned to PTF, aspirin or control groups during 18 months. We also determined the variations in the levels of inflammatory markers and Klotho (KL), a protein involved in maintaining cardiovascular health, and their relationship with the progression of SA.

Results: Patients treated with PTF presented a better evolution of CIMT, increased KL mRNA levels in peripheral blood cells (PBCs) and reduced the inflammatory state. The progression of CIMT values was inversely related to variations in KL both in serum and mRNA expression levels in PBCs. Multiple regression analysis demonstrated that PTF treatment and variations in mRNA KL expression in PBCs, together with changes in HDL, were significant determinants for the progression of CIMT (adjusted R2 = 0.24, P < 0.001) independently of traditional risk factors. Moreover, both variables constituted protective factors against a worst progression of CIMT [OR: 0.103 (P = 0.001) and 0.001 (P = 0.005), respectively].

Conclusions: PTF reduced SA progression assessed by CIMT variation, a beneficial effect related to KL gene expression in PBCs.

Trial registration: The study protocol code is PTF-AA-TR-2009 and the trial was registered on the European Union Drug Regulating Authorities Clinical Trials (EudraCT #2009-016595-77). The validation date was 2010-03-09.

背景:糖尿病肾病(DKD)与较高的心血管疾病(CVD)风险有关。五氧去氧肾上腺素(Pentoxifylline,PTF)是一种非选择性磷酸二酯酶抑制剂,具有抗炎、抗增生和抗纤维化作用,在临床试验和荟萃分析中均证明对肾脏有益。本研究旨在研究 PTF 对糖尿病和中重度慢性肾病(CKD)患者亚临床动脉粥样硬化(SA)进展的影响:在这项开放标签、随机对照、前瞻性的单中心试点研究中,我们测定了 102 名 2 型糖尿病和 CKD 患者的颈动脉内膜厚度(CIMT)和踝肱指数(ABI)的变化情况,这些患者被分配到 PTF、阿司匹林或对照组,为期 18 个月。我们还测定了炎症标志物和 Klotho(KL)(一种参与维持心血管健康的蛋白质)水平的变化及其与 SA 进展的关系:结果:接受 PTF 治疗的患者的 CIMT 变化较好,外周血细胞(PBCs)中的 KL mRNA 水平升高,炎症状态减轻。CIMT值的变化与血清中KL的变化和外周血细胞中mRNA的表达水平成反比。多元回归分析表明,PTF 治疗和 PBCs 中 KL mRNA 表达的变化以及 HDL 的变化是 CIMT 进展的重要决定因素(调整后 R2 = 0.24,P 结论):PTF可减少以CIMT变化评估的SA进展,这种有益效应与PBCs中KL基因的表达有关:研究方案代码为 PTF-AA-TR-2009,该试验已在欧盟药物管理局临床试验注册(EudraCT #2009-016595-77)。验证日期为 2010-03-09。
{"title":"Pentoxifylline ameliorates subclinical atherosclerosis progression in patients with type 2 diabetes and chronic kidney disease: a randomized pilot trial.","authors":"Javier Donate-Correa, Carla M Ferri, Carmen Mora-Fernández, Nayra Pérez-Delgado, Ainhoa González-Luis, Juan F Navarro-González","doi":"10.1186/s12933-024-02393-x","DOIUrl":"10.1186/s12933-024-02393-x","url":null,"abstract":"<p><strong>Background: </strong>Diabetic kidney disease (DKD) is associated with a higher risk of cardiovascular disease (CVD). Pentoxifylline (PTF), a nonselective phosphodiesterase inhibitor with anti-inflammatory, antiproliferative, and antifibrotic actions, has demonstrated renal benefits in both clinical trials and meta-analyses. The present work aimed to study the effects of PTF on the progression of subclinical atherosclerosis (SA) in a population of patients with diabetes and moderate to severe chronic kidney disease (CKD).</p><p><strong>Methods: </strong>In this open-label, randomized controlled, prospective single-center pilot study the evolution of carotid intima-media thickness (CIMT) and ankle-brachial index (ABI) were determined in 102 patients with type 2 diabetes mellitus and CKD assigned to PTF, aspirin or control groups during 18 months. We also determined the variations in the levels of inflammatory markers and Klotho (KL), a protein involved in maintaining cardiovascular health, and their relationship with the progression of SA.</p><p><strong>Results: </strong>Patients treated with PTF presented a better evolution of CIMT, increased KL mRNA levels in peripheral blood cells (PBCs) and reduced the inflammatory state. The progression of CIMT values was inversely related to variations in KL both in serum and mRNA expression levels in PBCs. Multiple regression analysis demonstrated that PTF treatment and variations in mRNA KL expression in PBCs, together with changes in HDL, were significant determinants for the progression of CIMT (adjusted R<sup>2</sup> = 0.24, P < 0.001) independently of traditional risk factors. Moreover, both variables constituted protective factors against a worst progression of CIMT [OR: 0.103 (P = 0.001) and 0.001 (P = 0.005), respectively].</p><p><strong>Conclusions: </strong>PTF reduced SA progression assessed by CIMT variation, a beneficial effect related to KL gene expression in PBCs.</p><p><strong>Trial registration: </strong>The study protocol code is PTF-AA-TR-2009 and the trial was registered on the European Union Drug Regulating Authorities Clinical Trials (EudraCT #2009-016595-77). The validation date was 2010-03-09.</p>","PeriodicalId":9374,"journal":{"name":"Cardiovascular Diabetology","volume":null,"pages":null},"PeriodicalIF":8.5,"publicationDate":"2024-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11344929/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142055034","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
An observational study of therapeutic procedures and in-hospital outcomes among patients admitted for acute myocardial infarction in Spain, 2016-2022: the role of diabetes mellitus. 2016-2022年西班牙急性心肌梗死住院患者治疗程序和院内预后观察研究:糖尿病的作用。
IF 8.5 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-08-24 DOI: 10.1186/s12933-024-02403-y
Jose M de-Miguel-Yanes, Rodrigo Jimenez-Garcia, Valentin Hernandez-Barrera, Javier de-Miguel-Diez, Ana Jimenez-Sierra, Jose J Zamorano-León, Natividad Cuadrado-Corrales, Ana Lopez-de-Andres

Background: We used the Spanish national hospital discharge data from 2016 to 2022 to analyze procedures and hospital outcomes among patients aged ≥ 18 years admitted for ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI) according to diabetes mellitus (DM) status (non-diabetic, type 1-DM or type 2-DM).

Methods: We built logistic regression models for STEMI/NSTEMI stratified by DM status to identify variables associated with in-hospital mortality (IHM). We analyzed the effect of DM on IHM.

Results: Spanish hospitals reported 201,950 STEMIs (72.7% non-diabetic, 0.5% type 1-DM, and 26.8% type 2-DM; 26.3% female) and 167,285 NSTEMIs (61.6% non-diabetic, 0.6% type 1-DM, and 37.8% type 2-DM; 30.9% female). In STEMI, the frequency of percutaneous coronary intervention (PCI) increased among non-diabetic people (60.4% vs. 68.6%; p < 0.001) and people with type 2-DM (53.6% vs. 66.1%; p < 0.001). In NSTEMI, the frequency of PCI increased among non-diabetic people (43.7% vs. 45.7%; p < 0.001) and people with type 2-DM (39.1% vs. 42.8%; p < 0.001). In NSTEMI, the frequency of coronary artery by-pass grafting (CABG) increased among non-diabetic people (2.8% vs. 3.5%; p < 0.001) and people with type 2-DM (3.7% vs. 5.0%; p < 0.001). In the entire population, lower IHM was associated with undergoing PCI (odds ratio [OR] [95% confidence interval] = 0.34 [0.32-0.35] in STEMI; 0.24 [0.23-0.26] in NSTEMI) or CABG (0.33 [0.27-0.40] in STEMI; 0.45 [0.38-0.53] in NSTEMI). IHM decreased over time in STEMI (OR = 0.86 [0.80-0.93]). Type 2-DM was associated with higher IHM in STEMI (OR = 1.06 [1.01-1.11]).

Conclusions: PCI and CABG were associated with lower IHM in people admitted for STEMI/NSTEMI. Type 2-DM was associated with IHM in STEMI.

背景:我们利用2016年至2022年西班牙全国医院出院数据,根据糖尿病(DM)状态(非糖尿病、1-DM型或2-DM型)分析了年龄≥18岁的ST段抬高型心肌梗死(STEMI)和非ST段抬高型心肌梗死(NSTEMI)入院患者的手术和住院结果:我们建立了按 DM 状态分层的 STEMI/NSTEMI 逻辑回归模型,以确定与院内死亡率 (IHM) 相关的变量。我们分析了糖尿病对院内死亡率的影响:西班牙医院报告了 201,950 例 STEMI(72.7% 为非糖尿病患者,0.5% 为 1 型糖尿病患者,26.8% 为 2 型糖尿病患者;26.3% 为女性)和 167,285 例 NSTEMI(61.6% 为非糖尿病患者,0.6% 为 1 型糖尿病患者,37.8% 为 2 型糖尿病患者;30.9% 为女性)。在 STEMI 中,非糖尿病患者接受经皮冠状动脉介入治疗(PCI)的频率增加(60.4% 对 68.6%;P 结论:PCI 和 CABG 与降低糖尿病患者的死亡率有关:在 STEMI/NSTEMI 患者中,PCI 和 CABG 与较低的 IHM 有关。在 STEMI 中,2 型糖尿病与 IHM 相关。
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引用次数: 0
Diagnostic and prognostic value of triglyceride glucose index: a comprehensive evaluation of meta-analysis. 甘油三酯葡萄糖指数的诊断和预后价值:荟萃分析的综合评估。
IF 8.5 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-08-23 DOI: 10.1186/s12933-024-02392-y
Sandeep Samethadka Nayak, Dona Kuriyakose, Lakshmi D Polisetty, Anjali Avinash Patil, Daniyal Ameen, Rakshita Bonu, Samatha P Shetty, Pubali Biswas, Micheal T Ulrich, Negin Letafatkar, Arman Habibi, Mohammad-Hossein Keivanlou, Sara Nobakht, Abdulhadi Alotaibi, Soheil Hassanipour, Ehsan Amini-Salehi

Objective: The present umbrella review aims to collate and summarize the findings from previous meta-analyses on the Triglyceride and Glucose (TyG) Index, providing insights to clinicians, researchers, and policymakers regarding the usefulness of this biomarker in various clinical settings.

Methods: A comprehensive search was conducted in PubMed, Scopus, and Web of Science up to April 14, 2024, without language restrictions. The AMSTAR2 checklist assessed the methodological quality of the included meta-analyses. Statistical analyses were performed using Comprehensive Meta-Analysis (CMA) software.

Results: A total of 32 studies were finally included. The results revealed significant associations between the TyG index and various health outcomes. For kidney outcomes, a high TyG index was significantly associated with an increased risk of contrast-induced nephropathy (CIN) (OR = 2.24, 95% CI: 1.82-2.77) and chronic kidney disease (CKD) (RR = 1.46, 95% CI: 1.32-1.63). High TyG index was significantly associated with an increased risk of type 2 diabetes mellitus (T2DM) (RR = 3.53, 95% CI: 2.74-4.54), gestational diabetes mellitus (GDM) (OR = 2.41, 95% CI: 1.48-3.91), and diabetic retinopathy (DR) (OR = 2.34, 95% CI: 1.31-4.19). Regarding metabolic diseases, the TyG index was significantly higher in patients with obstructive sleep apnea (OSA) (SMD = 0.86, 95% CI: 0.57-1.15), metabolic syndrome (MD = 0.83, 95% CI: 0.74-0.93), and non-alcoholic fatty liver disease (NAFLD) (OR = 2.36, 95% CI: 1.88-2.97) compared to those without these conditions. In cerebrovascular diseases, a higher TyG index was significantly associated with an increased risk of dementia (OR = 1.14, 95% CI: 1.12-1.16), cognitive impairment (OR = 2.31, 95% CI: 1.38-3.86), and ischemic stroke (OR = 1.37, 95% CI: 1.22-1.54). For cardiovascular outcomes, the TyG index showed significant associations with an increased risk of heart failure (HF) (HR = 1.21, 95% CI: 1.12-1.30), atrial fibrillation (AF) (SMD = 1.22, 95% CI: 0.57-1.87), and hypertension (HTN) (RR = 1.52, 95% CI: 1.25-1.85).

Conclusion: The TyG index is a promising biomarker for screening and predicting various medical conditions, particularly those related to insulin resistance and metabolic disorders. However, the heterogeneity and methodological quality of the included studies suggest the need for further high-quality research to confirm these findings and refine the clinical utility of the TyG index.

目的本综述旨在整理和总结以往有关甘油三酯和葡萄糖(TyG)指数的荟萃分析结果,为临床医生、研究人员和政策制定者提供有关该生物标志物在各种临床环境中有用性的见解:截至 2024 年 4 月 14 日,在 PubMed、Scopus 和 Web of Science 上进行了全面检索,无语言限制。AMSTAR2检查表评估了纳入的荟萃分析的方法学质量。统计分析使用综合荟萃分析(CMA)软件进行:最终共纳入 32 项研究。结果显示,TyG指数与各种健康结果之间存在明显关联。在肾脏预后方面,TyG指数高与造影剂诱发肾病(CIN)(OR = 2.24,95% CI:1.82-2.77)和慢性肾病(CKD)(RR = 1.46,95% CI:1.32-1.63)风险增加显著相关。TyG指数高与2型糖尿病(T2DM)(RR = 3.53,95% CI:2.74-4.54)、妊娠糖尿病(GDM)(OR = 2.41,95% CI:1.48-3.91)和糖尿病视网膜病变(DR)(OR = 2.34,95% CI:1.31-4.19)的风险增加明显相关。在代谢性疾病方面,患有阻塞性睡眠呼吸暂停(OSA)(SMD = 0.86,95% CI:0.57-1.15)、代谢综合征(MD = 0.83,95% CI:0.74-0.93)和非酒精性脂肪肝(NAFLD)(OR = 2.36,95% CI:1.88-2.97)的患者的TyG指数明显高于未患有这些疾病的患者。在脑血管疾病方面,TyG指数越高,患痴呆症(OR = 1.14,95% CI:1.12-1.16)、认知障碍(OR = 2.31,95% CI:1.38-3.86)和缺血性中风(OR = 1.37,95% CI:1.22-1.54)的风险越高。在心血管结果方面,TyG指数与心力衰竭(HF)(HR = 1.21,95% CI:1.12-1.30)、心房颤动(AF)(SMD = 1.22,95% CI:0.57-1.87)和高血压(HTN)(RR = 1.52,95% CI:1.25-1.85)风险增加有显著关联:TyG指数是一种很有前景的生物标志物,可用于筛查和预测各种疾病,尤其是与胰岛素抵抗和代谢紊乱有关的疾病。然而,所纳入研究的异质性和方法学质量表明,需要进一步开展高质量的研究,以证实这些发现并完善 TyG 指数的临床实用性。
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引用次数: 0
Epicardial and liver fat implications in albuminuria: a retrospective study. 心外膜和肝脏脂肪对白蛋白尿的影响:一项回顾性研究。
IF 8.5 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-08-22 DOI: 10.1186/s12933-024-02399-5
Carolina M Perdomo, Nerea Martin-Calvo, Ana Ezponda, Francisco J Mendoza, Gorka Bastarrika, Nuria Garcia-Fernandez, José I Herrero, Inmaculada Colina, Javier Escalada, Gema Frühbeck

Background: Albuminuria is considered an early and sensitive marker of kidney dysfunction, but also an independent cardiovascular risk factor. Considering the possible relationship among metabolic liver disease, cardiovascular disease and chronic kidney disease, we aimed to evaluate the risk of developing albuminuria regarding the presence of epicardial adipose tissue and the steatotic liver disease status.

Methods: A retrospective long-term longitudinal study including 181 patients was carried out. Epicardial adipose tissue and steatotic liver disease were assessed by computed tomography. The presence of albuminuria at follow-up was defined as the outcome.

Results: After a median follow up of 11.2 years, steatotic liver disease (HR 3.15; 95% CI, 1.20-8.26; p = 0.02) and excess amount of epicardial adipose tissue (HR 6.12; 95% CI, 1.69-22.19; p = 0.006) were associated with an increased risk of albuminuria after adjustment for visceral adipose tissue, sex, age, weight status, type 2 diabetes, prediabetes, hypertriglyceridemia, hypercholesterolemia, arterial hypertension, and cardiovascular prevention treatment at baseline. The presence of both conditions was associated with a higher risk of developing albuminuria compared to having steatotic liver disease alone (HR 5.91; 95% CI 1.15-30.41, p = 0.033). Compared with the first tertile of visceral adipose tissue, the proportion of subjects with liver steatosis and abnormal epicardial adipose tissue was significantly higher in the second and third tertile. We found a significant correlation between epicardial fat and steatotic liver disease (rho = 0.43 [p < 0.001]).

Conclusions: Identification and management/decrease of excess adiposity must be a target in the primary and secondary prevention of chronic kidney disease development and progression. Visceral adiposity assessment may be an adequate target in the daily clinical setting. Moreover, epicardial adipose tissue and steatotic liver disease assessment may aid in the primary prevention of renal dysfunction.

背景:白蛋白尿被认为是肾功能不全的早期敏感标志物,同时也是一个独立的心血管风险因素。考虑到代谢性肝病、心血管疾病和慢性肾病之间可能存在的关系,我们旨在评估心外膜脂肪组织的存在和脂肪性肝病状态导致白蛋白尿的风险:方法: 我们对 181 名患者进行了一项回顾性长期纵向研究。通过计算机断层扫描评估了心外膜脂肪组织和脂肪肝。结果:中位随访时间为 11.5 年:中位随访 11.2 年后,脂肪肝(HR 3.15;95% CI,1.20-8.26;P = 0.02)和心外膜脂肪组织过多(HR 6.12;95% CI,1.69-22.19;P = 0.在对内脏脂肪组织、性别、年龄、体重状况、2 型糖尿病、糖尿病前期、高甘油三酯血症、高胆固醇血症、动脉高血压和基线时的心血管预防治疗进行调整后,这两种情况都与白蛋白尿风险增加有关。与仅患有脂肪性肝病相比,同时患有这两种疾病的人患白蛋白尿的风险更高(HR 5.91;95% CI 1.15-30.41,p = 0.033)。与内脏脂肪组织的第一个三分位数相比,肝脏脂肪变性和心外膜脂肪组织异常的受试者比例在第二和第三个三分位数中明显较高。我们发现心外膜脂肪与脂肪性肝病之间存在明显的相关性(rho = 0.43 [p 结论:心外膜脂肪与脂肪性肝病之间存在明显的相关性:过多脂肪的识别和管理/减少必须成为慢性肾脏病发展和恶化的一级和二级预防的目标。在日常临床环境中,内脏脂肪含量评估可能是一个适当的目标。此外,心外膜脂肪组织和脂肪肝评估也有助于肾功能障碍的一级预防。
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Cardiovascular Diabetology
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