Periodontitis links to exacerbation of myocardial dysfunction in subjects with type 2 diabetes.

Abstract

Subjects with diabetes and periodontitis are at high risk of cardiovascular events, while the subclinical alterations of cardiac function in this cohort remain unclear. This cross-sectional study investigated the association of periodontitis with left ventricle (LV) structural and functional abnormalities in subjects with type 2 diabetes mellitus (T2DM). A total of 115 subjects with T2DM were divided into Control group (n=32) with no or mild periodontitis, and the rest with moderate to severe chronic periodontitis (CP) were further categorized into CP-1 (n=41) and CP-2 (n=42) based on disease severity. Echocardiography was performed to precisely assess (a) LV hypertrophy by LV mass index (LVMi); (b) LV diastolic function by tissue Doppler imaging index E/e' ratio; and (c) LV systolic function by speckle tracking derived global longitudinal strain (GLS). Overall, a linear trend in LVMi, E/e', and GLS existed among the Control, CP-1, and CP-2 groups, respectively (P<0.05). After adjustments of multiple confounders, CP-2 subjects showed significantly higher E/e' (log scale, 2.22±0.05 vs 2.07±0.06, P<0.01) and GLS (-17.42±0.46% vs -18.95±0.54%, P<0.05) than the Controls. Multivariate analysis revealed that sites% with probing depth ≥4mm and sites% with clinical attachment loss ≥5mm were independent indicators for E/e' (β=0.005 and β=0.002, P<0.01) and GLS (β=0.03 and β=0.02, P<0.05) , respectively. Moreover, the number of missing teeth was significantly associated with LVMi (β=0.01, P<0.01). This study provides the first evidence that severe periodontitis is significantly associated with the exacerbation of LV diastolic and systolic dysfunction in subjects with T2DM.