Relations of insulin resistance and glycemic abnormalities to cardiovascular magnetic resonance measures of cardiac structure and function: the Framingham Heart Study.
Relations of insulin resistance and glycemic abnormalities to cardiovascular magnetic resonance measures of cardiac structure and function: the Framingham Heart Study.
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DOI：
10.1161/circimaging.109.911438
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发表时间：
2010-05
期刊：
影响因子：
--
通讯作者：
O'Donnell CJ
中科院分区：
文献类型：
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作者：
Velagaleti RS;Gona P;Chuang ML;Salton CJ;Fox CS;Blease SJ;Yeon SB;Manning WJ;O'Donnell CJ
关于糖尿病、胰岛素抵抗和亚临床高胰岛素血症/高血糖症与心脏结构和功能的关系的数据相互矛盾。我们试图在自由生活队列中应用容积心血管磁共振（CMR）来潜在地澄清这些关联。共有1603名心脏研究后代参与者（年龄64±9岁; 55%为女性）接受了CMR，以确定左心室质量（LVM）、左心室质量与舒张末期容积比（LVM/LVEDV）、相对室壁厚度（RWT）、射血分数（EF）、心输出量（CO）和左心房大小（LAD）。测定关于胰岛素抵抗（稳态模型，HOMA-IR）和胰岛素抵抗类别（正常、受损的胰岛素血症或胰岛素抵抗、糖尿病前期和糖尿病）的数据。在一个接受口服葡萄糖耐量试验的亚组（253名男性，290名女性）中，我们将2小时胰岛素和葡萄糖与CMR测量值相关联。在男性和女性中，HOMA-IR四分位数的所有年龄校正CMR指标均增加，但多变量校正趋势仅对LVM/ht2.7和LVM/LVEDV有意义。在年龄校正模型中，糖尿病前期和糖尿病（男女）参与者的左心室质量/左心室舒张末期容积和右心室重量较高，但仅在男性中进行多变量校正后，这些相关性仍显着。在男性中，左心室质量/左心室舒张末期容积与2小时胰岛素显著相关，在女性中，右心室重量与2小时血糖显著相关。在多变量逐步选择分析中，纳入BMI导致统计学显著性损失。虽然胰岛素和葡萄糖指数与心脏结构异常相关，但胰岛素抵抗和心功能恶化始终与左心室质量/左心室舒张末期容积独立相关。这些数据暗示高血糖和胰岛素抵抗在向心性左心室重构。
Data regarding the relationships of diabetes, insulin resistance and sub-clinical hyperinsulinemia/hyperglycemia with cardiac structure and function are conflicting. We sought to apply volumetric cardiovascular magnetic resonance (CMR) in a free-living cohort to potentially clarify these associations. A total of 1603 Framingham Heart Study Offspring participants (age 64±9 years; 55% women) underwent CMR to determine left ventricular mass (LVM), LVM to end-diastolic volume ratio (LVM/LVEDV), relative wall thickness (RWT), ejection fraction (EF), cardiac output (CO) and left atrial size (LAD). Data regarding insulin resistance (homeostasis model, HOMA-IR) and glycemia categories (normal, impaired insulinemia or glycemia, pre-diabetes and diabetes) were determined. In a subgroup (253 men, 290 women) that underwent oral glucose tolerance testing, we related 2-hr insulin and glucose with CMR measures. In both men and women, all age-adjusted CMR measures increased across HOMA-IR quartiles, but multivariable-adjusted trends were significant only for LVM/ht2.7 and LVM/LVEDV. LVM/LVEDV and RWT were higher in participants with pre-diabetes and diabetes (in both sexes) in age-adjusted models, but these associations remained significant after multivariable-adjustment only in men. LVM/LVEDV was significantly associated with 2-hr insulin in men only, and RWT was significantly associated with 2-hr glucose in women only. In multivariable stepwise selection analyses, the inclusion of BMI led to a loss in statistical significance. While insulin and glucose indices are associated with abnormalities in cardiac structure, insulin resistance and worsening glycemia are consistently and independently associated with LVM/LVEDV. These data implicate hyperglycemia and insulin resistance in concentric LV remodeling.