Clinical Implications of Echocardiographic Phenotypes of Patients With Diabetes Mellitus
Clinical Implications of Echocardiographic Phenotypes of Patients With Diabetes Mellitus
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DOI：
10.1016/j.jacc.2017.07.792
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发表时间：
2017-10-03
影响因子：
24
通讯作者：
Derumeaux, Genevieve
中科院分区：
文献类型：
--
作者：
Ernande, Laura;Audureau, Etienne;Derumeaux, Genevieve
背景2型糖尿病（T2 DM）可改变心脏结构和功能，但肥胖、高血压（HTN）、结论本研究试图通过聚类分析将T2 DM患者的心脏表型与临床特征和结局联系起来。在来自2个前瞻性队列的842例T2 DM患者中评价了心血管死亡率和住院率。对超声心动图变量进行聚类分析，并评估聚类与临床特征和结局之间的相关性。第1组患者的左心室（LV）质量指数和早期二尖瓣流入速度与二尖瓣环舒张早期速度（E/e '）比值最低，左心室射血分数（LVEF）最高，且主要为男性，肥胖或HTN发生率最低。第2组患者具有最高的应变和最高的E/e'比率，年龄最大，主要为女性，并且具有最低的孤立T2 DM（没有HTN或肥胖）率。第3组患者具有最高的LV质量指数和体积以及最低的LVEF和应变，主要为男性，并且与第1组患者具有相似的年龄和肥胖率以及HTN。随访67个月（四分位距：40 - 87）后，521例患者中有56例（10.8%）发生复合终点。聚类2（风险比：2.37; 95%置信区间：1.15至4.88）和3（风险比：2.19; 95%置信区间：1.00至4.82）具有类似的结果，结论：超声心动图变量的聚类分析确定了3种不同的T2 DM患者超声心动图表型，这些表型与不同的临床特征相关，并强调了LV重构和亚临床功能障碍(C)2017年由美国心脏病学会基金会。
BACKGROUND Type 2 diabetes mellitus (T2DM) may alter cardiac structure and function, but obesity, hypertension (HTN), or aging can induce similar abnormalities.OBJECTIVES This study sought to link cardiac phenotypes in T2DM patients with clinical profiles and outcomes using cluster analysis.METHODS Baseline echocardiography and a composite endpoint (cardiovascular mortality and hospitalization) were evaluated in 842 T2DM patients from 2 prospective cohorts. A cluster analysis was performed on echocardiographic variables, and the association between clusters and clinical profiles and outcomes was assessed.RESULTS Three clusters were identified. Cluster 1 patients had the lowest left ventricular (LV) mass index and ratio between early mitral inflow velocity and mitral annular early diastolic velocity (E/e') ratio, had the highest left ventricular ejection fraction (LVEF), and were predominantly male with the lowest rate of obesity or HTN. Cluster 2 patients had the highest strain and highest E/e' ratio, were the oldest, were predominantly female, and had the lowest rate of isolated T2DM (without HTN or obesity). Cluster 3 patients had the highest LV mass index and volumes and the lowest LVEF and strain, were predominantly male, and shared similar age and rate of obesity and HTN as cluster 1 patients. After follow-up of 67 months (interquartile range: 40 to 87), the composite endpoint occurred in 56 of 521 patients (10.8%). Clusters 2 (hazard ratio: 2.37; 95% confidence interval: 1.15 to 4.88) and 3 (hazard ratio: 2.19; 95% confidence interval: 1.00 to 4.82) had a similar outcome, which was worse than cluster 1.CONCLUSIONS Cluster analysis of echocardiographic variables identified 3 different echocardiographic phenotypes of T2DM patients that were associated with distinct clinical profiles and highlighted the prognostic value of LV remodeling and subclinical dysfunction. (C) 2017 by the American College of Cardiology Foundation.