Background
Methods
Study populations
Echocardiographic examination
Assessment of GLS
Assessment of DM-related clinical features
Statistical analysis
Results
Baseline characteristics
All patients (n = 144)
|
Patients with GLS ≥ 18% (n = 91)
|
Patients with GLS < 18% (n = 53)
|
p value
| |
---|---|---|---|---|
Clinical Data
| ||||
Age, years | 57 ± 15 | 57 ± 15 | 57 ± 15 | 0.75 |
Female, n (%) | 79(55) | 55(60) | 24(45) | 0.09 |
Height, m | 1.6 ± 1.0 | 1.6 ± 0.9 | 1.6 ± 1.0 | 0.20 |
Weight, kg | 64 ± 15 | 60 ± 12 | 72 ± 18 | <0.001 |
Body Mass Index, kg/m2
| 24.7 ± 4.9 | 23 ± 3.9 | 27 ± 6.0 | <0.001 |
Systolic blood pressure, mmHg | 124 ± 19 | 122 ± 17 | 130 ± 21 | 0.007 |
Diastolic blood pressure, mmHg | 73 ± 11 | 71 ± 11 | 76 ± 10 | 0.002 |
Pulse pressure, mmHg | 53 ± 15 | 51 ± 14 | 55 ± 17 | 0.03 |
Heart rate, bpm | 69 ± 11 | 67 ± 11 | 71 ± 10 | 0.04 |
Rate Pressure Product, bpm*mmHg | 9173 ± 1992 | 8741 ± 1812 | 9905 ± 2052 | <0.001 |
Obesity, n (%) | 58(40) | 25(27) | 33(62) | <0.001 |
Type 2 DM, n (%) | 104(72) | 55(60) | 49(92) | <0.001 |
DM duration, years | 11.8 ± 9.6 | 10.4 ± 8.4 | 13.6 ± 10.1 | 0.04 |
Hypertension, n (%) | 69(48) | 39(43) | 30(57) | 0.12 |
Dyslipidemia, n (%) | 89(62) | 53(58) | 36(68) | 0.29 |
Hypertriglyceridemia, n (%) | 44(31) | 17(19) | 27(51) | <0.001 |
Smoking, n (%) | 31(22) | 29(32) | 25(47) | 0.53 |
Complications
| ||||
Nephropathy, n (%) | 54(38) | 13(14) | 34(64) | <0.001 |
Neuropathy, n (%) | 47(33) | 19(21) | 29(55) | <0.001 |
Retinopathy, n (%) | 48(33) | 29(32) | 25(47) | 0.07 |
Biochemistry and Urinary Examination
| ||||
HbA1c, % | 8.2(7.0-9.6) | 8.0(6.8-9.0) | 8.7(7.3-10.0) | 0.21 |
1,5-anhydroglucitol, g/dl | 4.3(2.4-8.1) | 5.1(2.7-8.6) | 3.3(2.0-7.1) | 0.07 |
Glycoalbumin, % | 21.8(17.4-27.2) | 21.8(18.0-28.4) | 22.0(16.8-26.8) | 0.52 |
HOMA index | 1.9(1.1-4.1) | 1.5(1.0-3.0) | 2.5(1.3-4.8) | 0.049 |
Low-density lipoprotein, mg/dl | 103 ± 35 | 100 ± 35 | 107 ± 34 | 0.22 |
High-density lipoprotein, mg/dl | 53 ± 17 | 54 ± 16 | 50 ± 17 | 0.23 |
Triglyceride, mg/dl | 112(78–159) | 96(66–132) | 154(113–203) | <0.001 |
eGFR, ml/min/1.73 m2
| 77(61–89) | 77(64–89) | 74(58–90) | 0.26 |
Albuminuria, mg/day | 11.5(4.5-33.0) | 7.0(3.0-18.0) | 39.0(11.0-181.3) | <0.001 |
Medications
| ||||
Calcium channel blocker, n (%) | 38(26) | 21(23) | 17(32) | 0.25 |
ACEI/ARB, n (%) | 58(40) | 30(33) | 28(53) | 0.02 |
β-blocker, n (%) | 13(9) | 6(7) | 7(13) | 0.23 |
Diuretics, n (%) | 10(7) | 4(4) | 6(11) | 0.17 |
Statin, n (%) | 68(47) | 36(40) | 32(60) | 0.02 |
Insulin, n (%) | 90(63) | 58(64) | 32(60) | 0.72 |
DPP-4I, n (%) | 55(38) | 30(33) | 25(47) | 0.11 |
GLP-1RA, n (%) | 13(9) | 7(7) | 6(11) | 0.55 |
Sulfonylurea, n (%) | 26(18) | 15(16) | 11(21) | 051 |
α-GI, n (%) | 26(18) | 15(16) | 11(21) | 0.51 |
Thiazolidine, n (%) | 13(9) | 6(6) | 7(13) | 0.23 |
Metformin, n (%) | 59(41) | 31(34) | 28(53) | 0.04 |
Echocardiography
| ||||
Relative wall thickness | 0.45(0.39-0.51) | 0.41(0.36-0.47) | 0.49(0.47-0.60) | <0.001 |
Left atrial volume index, ml/m2
| 28(22–34) | 27(22–33) | 31(23–37) | 0.07 |
LV mass index, g/m2
| 75(63–86) | 68(57–80) | 83(74–94) | <0.001 |
LV mass index, g/m2.7
| 34(27–41) | 30(25–37) | 41(33–46) | <0.001 |
End-systolic volume, ml | 26 ± 10 | 24 ± 9 | 29 ± 12 | 0.004 |
End-diastolic volume, ml | 75 ± 22 | 71 ± 21 | 80 ± 23 | 0.004 |
LV ejection fraction, % | 66 ± 4 | 67 ± 4 | 65 ± 5 | 0.002 |
Stroke volume, ml | 62(56–72) | 62(56–73) | 63(56–69) | 0.68 |
E/A | 0.83(0.68-1.1) | 0.86(0.7-1.2) | 0.77(0.66-0.95) | 0.03 |
E-wave deceleration time | 189(163–227) | 190(158–225) | 187(167–235) | 0.54 |
E’ | 6.3(5.0-7.5) | 6.5(5.6-8.1) | 5.6(4.4-6.7) | <0.001 |
E/E’ | 9.6(8.0-11.6) | 9.1(7.7-11.3) | 10.3(9.1-13.5) | 0.002 |
Global longitudinal strain, % | 18.8 ± 2.7 | 20.4 ± 1.6 | 16.1 ± 1.7 | <0.001 |
Comparison of baseline characteristics of patients with GLS < 18% and ≥18%
Comparison of echocardiographic parameters for patients with GLS < 18% and ≥18%
Predictors of reduced GLS for DM patients
Univariate
|
Multivariate
| |||||
---|---|---|---|---|---|---|
Dependent variables
|
OR
|
95% CI
|
p value
|
OR
|
95% CI
|
p value
|
Age | 0.99 | 0.974-1.019 | 0.75 | |||
DM duration | 1.03 | 0.996-1.069 | 0.08 | |||
Gender (female) | 0.54 | 0.273-1.075 | 0.08 | |||
Type 2 DM | 8.02 | 2.663-24.15 | <0.001 | 5.39 | 1.329-21.86 | 0.02 |
Obesity | 4.36 | 2.117-8.961 | <0.001 | 2.96 | 1.201-7.312 | 0.02 |
Hypertension | 1.74 | 0.878-3.446 | 0.11 | |||
Hypertriglyceridemia | 4.52 | 2.128-9.604 | 0.001 | 3.43 | 1.347-8.739 | 0.001 |
Nephropathy | 10.7 | 4.765-24.19 | <0.001 | 5.26 | 2.111-13.12 | <0.001 |
Neuropathy | 4.58 | 2.184-9.600 | <0.001 | 4.52 | 1.734-11.80 | 0.002 |
Retinopathy | 2.21 | 1.105-4.439 | 0.02 |
Association of clinical features with LV geometry and function
Variable
|
LV mass index
|
Relative wall thickness
|
LVEF
|
E/E’
|
GLS
| |||||
---|---|---|---|---|---|---|---|---|---|---|
β
|
p value
|
β
|
p value
|
β
|
p value
|
β
|
p value
|
β
|
p value
| |
Age | 0.28 | <0.001 | 0.46 | <0.001 | ||||||
DM duration | ||||||||||
Gender (female) | 0.17 | 0.012 | 0.22 | 0.004 | ||||||
Type 2 DM | 0.28 | <0.001 | ||||||||
Body mass index | 0.18 | 0.023 | 0.29 | <0.001 | −0.20 | 0.006 | ||||
Systolic blood pressure | 0.22 | 0.007 | 0.21 | 0.005 | ||||||
Triglyceride | −0.24 | 0.001 | ||||||||
Albuminuria | 0.27 | 0.001 | 0.29 | 0.001 | −0.33 | <0.001 | ||||
Neuropathy | 0.15 | 0.039 | −0.18 | 0.014 | ||||||
Retinopathy | 0.18 | 0.016 | 0.20 | 0.012 |