Abstract
BackgroundCoronary artery disease (CAD) confers considerable morbidity and mortality in diabetes. However, the role of CAD in additive effect of left ventricular (LV) function has rarely been explored in type 2 diabetes mellitus (T2DM) patients. This study aimed to investigate how CAD affect LV systolic and diastolic function in T2DM patients.Materials and methodsA total of 282 T2DM patients {104 patients with CAD [T2DM (CAD +)] and 178 without [T2DM (CAD −)]} and 83 sex- and age- matched healthy controls underwent cardiac magnetic resonance scanning. LV structure, function, global strains [including systolic peak strain (PS), peak systolic (PSSR) and diastolic strain rate (PDSR) in radial, circumferential and longitudinal directions] and late gadolinium enhancement (LGE) parameters were measured. T2DM (CAD +) patients were divided into two subgroups based on the median of Gensini score (60) which was calculated to assess the severity of CAD. Multivariable linear regression analyses were constructed to investigate the determinants of reduced LV function.ResultsCompared with normal controls, T2DM (CAD −) patients exhibited increased LV end-diastolic and end-systolic volume index and decreased LV global strains, while T2DM(CAD +) patients showed more marked increase and decrease than T2DM(CAD-) and healthy controls, except for longitudinal PDSR (PDSR-L) (all P < 0.017). All of LV global strains demonstrated a progressive decrease from normal controls, through Gensini score ≤ 60, to Gensini score > 60 group, except for PDSR-L (all P < 0.017). CAD was an independent predictor of reduced LV global circumferential PS (GCPS, β = 0.22, p < 0.001), PSSR (PSSR-C, β = 0.17, p = 0.005), PDSR (PDSR-C, β = 0.22, p < 0.001), global radial PS (GRPS, β = 0.19, p = 0.001), and global longitudinal PS (GLPS, β = 0.18, p = 0.003) in T2DM. The Gensini score was associated with decreased GCPS, PSSR-C, PDSR-C, GRPS, and GLPS in T2DM (CAD +) (all p < 0.05).ConclusionCAD has an additive deleterious effect on LV systolic and diastolic function in T2DM patients. Among T2DM (CAD +) patients, the Gensini score is associated with reduced LV contractile and diastolic function.Trial registration Retrospectively registered
Highlights
Coronary artery disease (CAD) confers considerable morbidity and mortality in diabetes
All of left ventricular (LV) global strains demonstrated a progressive decrease from normal controls, through Gensini score ≤ 60, to Gensini score > 60 group, except for peak diastolic strain rate (PDSR)-L
CAD was an independent predictor of reduced LV global circumferential peak strain (PS) (GCPS, β = 0.22, p < 0.001), peak systolic strain rate (PSSR) (PSSR-C, β = 0.17, p = 0.005), PDSR (PDSR-C, β =0.22, p < 0.001), global radial PS (GRPS, β = 0.19, p = 0.001), and global longitudinal PS (GLPS, β = 0.18, p = 0.003) in type 2 diabetes mellitus (T2DM)
Summary
Coronary artery disease (CAD) confers considerable morbidity and mortality in diabetes. The role of CAD in additive effect of left ventricular (LV) function has rarely been explored in type 2 diabetes mellitus (T2DM) patients. This study aimed to investigate how CAD affect LV systolic and diastolic function in T2DM patients. All forms of cardiovascular disease are common complications of diabetes mellitus that confers considerable morbidity and mortality [1, 2]. Mounting evidence suggest that type 2 diabetes mellitus (T2DM) can directly affect the myocardium, resulting in microvascular dysfunction, myocardial fibrosis, and left ventricular (LV) hypertrophy [3, 4]. It is well documented that T2DM associated with an exaggerated risk of macrovascular complication, such as coronary artery disease (CAD) [5]. A better understanding of the underlying influences of CAD on T2DM regarding cardiac function may be of paramount importance to improve our management efforts and reduce the incidence of long-term adverse events
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