Background
Materials and methods
Study population
CMR protocol
CMR image analysis
Assessment of the reproducibility of perfusion parameters
Statistical analysis
Results
Baseline characteristics
Controls (n = 79) | DM patients (n = 120) | P value∂ | P value‡ | P value∆ | |||||||
---|---|---|---|---|---|---|---|---|---|---|---|
Normal-weight (n = 33) | Overweight (n = 27) | Obese (n = 19) | P valueå | Normal-weight (n = 51) | Overweight (n = 29) | Obese (n = 40) | P valueß | ||||
Age (y) | 55.27 ± 8.18 | 54.59 ± 9.12 | 56.89 ± 9.79 | 0.462 | 55.06 ± 13.21 | 58.00 ± 10.05 | 57.00 ± 11.09 | 0.541 | 0.935 | 0.202 | 0.972 |
Female | 13 (39.3%) | 13 (29.6%) | 9 (42.1%) | 0.680 | 28 (54.9%) | 10 (27.6%) | 17 (35.0%) | 0.577 | 0.186 | 0.416 | 0.784 |
BMI (kg/m2) | 21.94 ± 1.01 | 24.00 ± 0.55* | 26.53 ± 0.90* § | 0.000 | 21.26 ± 1.21 | 23.75 ± 0.56 * | 26.92 ± 1.59 * § | 0.000 | 0.073 | 0.114 | 0.227 |
Smoking history | 8 (24.2%) | 8 (29.6%) | 7 (36.8%) | 0.627 | 9 (17.6%) | 8 (27.6%) | 10 (25.0%) | 0.532 | 0.580 | 0.550 | 0.372 |
Diabetes duration (y) | – | – | – | – | 6.51 ± 4.89 | 9.28 ± 6.51 | 9.35 ± 6.11 | 0.033 | – | – | – |
SBP (mm Hg) | 121.0 ± 11.7 | 119.7 ± 14.2 | 121.0 ± 13.1 | 0.917 | 127.8 ± 16.9 | 132.9 ± 22.3 | 129.1 ± 14.4 | 0.515 | 0.026 | 0.017 | 0.071 |
DBP (mm Hg) | 77.0 ± 8.8 | 78.7 ± 9.5 | 73.6 ± 9.8 | 0.197 | 81.3 ± 12.7 | 79.5 ± 10.0 | 79.4 ± 9.7 | 0.748 | 0.101 | 0.743 | 0.052 |
HbA1c (%) | 5.32 ± 0.44 | 5.41 ± 0.51 | 5.38 ± 0.48 | 0.815 | 7.9 ± 2.4 | 7.8 ± 2.2 | 7.9 ± 1.6 | 0.944 | 0.000 | 0.000 | 0.000 |
TG (mmol/L) | 1.32 ± 0.57 | 1.85 ± 1.25 | 2.12 ± 1.55 | 0.034 | 1.59 ± 1.34 | 1.54 ± 0.75 | 2.39 ± 2.87 | 0.090 | 0.278 | 0.262 | 0.706 |
TC (mmol/L) | 4.21 ± 0.95 | 4.51 ± 0.96 | 4.98 ± 1.52 | 0.535 | 4.36 ± 1.18 | 4.18 ± 0.71 | 4.36 ± 1.25 | 0.759 | 0.869 | 0.496 | 0.463 |
HDL (mmol/L) | 1.34 ± 0.14 | 1.38 ± 0.52 | 1.42 ± 0.27 | 0.727 | 1.48 ± 0.50 | 1.18 ± 0.33 | 1.30 ± 01.01* | 0.153 | 0.122 | 0.091 | 0.616 |
LDL (mmol/L) | 2.52 ± 0.49 | 2.49 ± 0.77 | 2.29 ± 0.85 | 0.485 | 2.58 ± 0.85 | 2.41 ± 0.59 | 2.39 ± 0.77 | 0.453 | 0.738 | 0.656 | 0.650 |
eGFR (mL/min) | 95.39 ± 9.39 | 98.76 ± 11.14 | 98.28 ± 8.72 | 0.371 | 89.66 ± 21.41 | 85.81 ± 24.33 | 87.30 ± 25.72 | 0.766 | 0.097 | 0.013 | 0.019 |
Cardiac troponin I (ug/L) - | – | – | – | 0.025 ± 0.023 | 0.022 ± 0.009 | 0.029 ± 0.013 | 0.197 | – | – | – | |
Atrial fibrillation | – | – | – | – | 0 | 1 (3.4%) | 1 (2.5%) | 0.450 | – | – | – |
Renal dysfunction^ | – | – | – | – | 8 (15.7%) | 6 (20.7%) | 9 (22.5%) | 0.695 | – | – | – |
Retinopathy | – | – | – | – | 4 (7.8%) | 3 (10.3%) | 6 (15.0%) | 0.549 | – | – | – |
Peripheral neuropathy | – | – | – | – | 13 (25.5%) | 10 (34.5%) | 18 (45.0%) | 0.124 | – | – | – |
Biguanides | – | – | – | – | 18 (35.3%) | 13 (44.8%) | 21 (52.5%) | 0.254 | – | – | – |
Sulfonylureas | – | – | – | – | 9 (17.6%) | 4 (13.7%) | 10 (25.0%) | 0.474 | – | – | – |
α-Glucosidase inhibitor | – | – | – | – | 13 (25.5%) | 11 (37.9%) | 18 (45.0%) | 0.140 | – | – | – |
GLP-1/DPP-4 inhibitor | – | – | – | – | 3 (5.9%) | 2 (6.9%) | 2 (5.0%) | 0.946 | – | – | – |
Insulin | – | – | – | – | 12 (23.5%) | 8 (27.6%) | 6 (15.0%) | 0.417 | – | – | – |
ACEI/ARB | – | – | – | – | 9 (17.6%) | 6 (20.7%) | 8 (20.0%) | 0.934 | – | – | – |
Statin | – | – | – | – | 4 (7.8%) | 7 (24.1%) | 8 (20.0%) | 0.107 | – | – | – |
LVEDV/BSA (ml/m2) | 73.53 ± 13.54 | 78.71 ± 17.55 | 76.30 ± 13.77 | 0.418 | 80.21 ± 24.54 | 80.56 ± 20.30 | 70.31 ± 12.41 | 0.040 | 0.157 | 0.717 | 0.100 |
LVESV/BSA (ml/m2) | 29.89 ± 11.68 | 32.37 ± 14.67 | 33.18 ± 18.51 | 0.685 | 32.98 ± 18.77 | 32.71 ± 16.69 | 29.33 ± 10.81 | 0.519 | 0.400 | 0.937 | 0.318 |
LVEF (%) | 61.68 ± 4.82 | 60.52 ± 8.11 | 61.86 ± 5.71 | 0.718 | 60.11 ± 7.75 | 61.39 ± 12.09 | 59.64 ± 9.04 | 0.738 | 0.301 | 0.755 | 0.343 |
LV mass/BSA (g/m2) | 47.26 ± 15.33 | 49.75 ± 18.76 | 50.87 ± 10.37 | 0.685 | 52.62 ± 19.41 | 56.93 ± 13.55 | 52.67 ± 14.15 | 0.479 | 0.185 | 0.105 | 0.617 |
Rest heart rate | 70.6 ± 11.4 | 73.5 ± 11.9 | 72.5 ± 9.0 | 0.585 | 74.9 ± 12.1 | 71.4 ± 10.0 | 73.4 ± 9.4 | 0.396 | 0.110 | 0.483 | 0.732 |
LV remodeling index# | 0.59 ± 0.11 | 0.64 ± 0.13 | 0.69 ± 0.16 | 0.047 | 0.66 ± 0.14 | 0.72 ± 0.13 | 0.75 ± 0.15* | 0.008 | 0.020 | 0.046 | 0.157 |
Comparison of the microvascular function between the T2DM and control groups
Microvascular function gradually decreases with increasing BMI in all patients
Controls (n = 79) | DM patients (n = 120) | ||||||||
---|---|---|---|---|---|---|---|---|---|
Normal-weight (n = 33) | Overweight (n = 27) | Obese (n = 19) | P valueå | Normal-weight (n = 51) | Overweight (n = 29) | Obese (n = 40) | P valueß | ||
Basal | |||||||||
Upslope | 2.26 ± 0.84 | 1.82 ± 0.55 | 1.35 ± 0.42* | 0.000 | 1.85 ± 0.53 | 1.40 ± 0.34* | 1.10 ± 0.35* § | 0.000 | |
TTM (sec) | 25.22 ± 10.85 | 32.17 ± 17.42 | 33.17 ± 14.12 | 0.084 | 35.36 ± 17.05 | 35.75 ± 18.83 | 35.36 ± 15.52 | 0.929 | |
MaxSI | 17.24 ± 6.54 | 16.27 ± 4.14 | 13.24 ± 3.07* | 0.028 | 16.34 ± 5.18 | 11.33 ± 3.76* | 9.33 ± 3.01* | 0.000 | |
MaxSI (- baseline) | 15.93 ± 4.26 | 13.29 ± 4.61 | 10.62 ± 2.65* | 0.000 | 12.63 ± 4.40 | 8.06 ± 2.58* | 7.31 ± 2.52* | 0.000 | |
SI (baseline) | 3.72 ± 1.43 | 3.35 ± 0.95 | 2.63 ± 0.80* | 0.006 | 3.13 ± 1.42 | 2.29 ± 0.87* | 2.20 ± 0.95* | 0.000 | |
Mid-ventricular | |||||||||
Upslope | 2.93 ± 1.03 | 2.31 ± 0.72* | 1.80 ± 0.60* | 0.000 | 2.37 ± 0.70 | 1.99 ± 0.54* | 1.37 ± 0.41* § | 0.000 | |
TTM (sec) | 27.31 ± 13.86 | 31.68 ± 16.61 | 33.25 ± 13.83 | 0.313 | 34.19 ± 16.14 | 35.93 ± 20.13 | 34.26 ± 12.55 | 0.884 | |
MaxSI | 21.78 ± 7.83 | 20.59 ± 5.32 | 16.58 ± 3.96* | 0.018 | 21.29 ± 6.54 | 15.01 ± 4.14* | 12.22 ± 3.91* | 0.000 | |
MaxSI (- baseline) | 19.63 ± 5.25 | 16.74 ± 5.41 | 13.14 ± 3.42* | 0.000 | 16.38 ± 5.39 | 10.83 ± 3.48* | 9.49 ± 3.33* | 0.000 | |
SI (Baseline) | 4.83 ± 1.60 | 4.36 ± 1.51 | 3.39 ± 0.96* | 0.004 | 4.22 ± 1.73 | 3.08 ± 1.00* | 2.86 ± 1.06* | 0.000 | |
Apex | |||||||||
Upslope | 3.69 ± 1.19 | 2.95 ± 0.85* | 2.19 ± 0.62* | 0.000 | 3.03 ± 0.91 | 2.44 ± 0.70* | 1.80 ± 0.57* § | 0.000 | |
TTM (sec) | 27.81 ± 13.87 | 32.43 ± 16.55 | 35.01 ± 14.62 | 0.221 | 34.20 ± 15.75 | 36.74 ± 19.94 | 35.26 ± 13.31 | 0.794 | |
MaxSI | 26.90 ± 10.28 | 26.67 ± 6.84 | 20.76 ± 4.42 | 0.021 | 24.42 ± 8.50 | 19.94 ± 5.17* | 16.19 ± 4.91* | 0.000 | |
MaxSI (- baseline) | 24.32 ± 7.72 | 21.37 ± 5.41 | 16.50 ± 4.03* | 0.000 | 21.52 ± 7.40 | 13.82 ± 4.21* | 12.68 ± 4.10* | 0.000 | |
SI (baseline) | 5.80 ± 2.06 | 5.27 ± 2.05 | 4.36 ± 1.47 | 0.041 | 5.57 ± 2.16 | 4.15 ± 1.33* | 3.70 ± 1.38* | 0.000 |
The linear regression analysis of microvascular function in all T2DM patients
Univariable | Multivariablea | ||||
---|---|---|---|---|---|
β | P value | β | P value | R2 | |
Age (y)∆ | − 0.048 | 0.501 | – | – | 0.567 |
Sex (female) | 0.351 | 0.000 | 0.372 | 0.000 | |
BMI (kg/m2) | − 0.581 | 0.000 | − 0.516 | 0.000 | |
Diabetes duration (year) | − 0.347 | 0.000 | − 0.169 | 0.022 | |
HbA1c (%) | − 0.314 | 0.000 | − 0.184 | 0.010 | |
TG (mmol/L) | − 0.153 | 0.031 | – | – | |
SBP (mm Hg)∆ | 0.036 | 0.727 | – | – | |
eGFR (mL/min) ∆ | 0.093 | 0.313 | – | – | |
LV remodeling index | − 0.270 | 0.000 | – | – |
The ROC curve analysis of individuals on global upslope in the same BMI scale for discriminating the additive effect of T2DM status
The logistic regression analysis for independent predictors of myocardial microvascular dysfunction
Normal–weight group | Overweight group | Obese group | ||||
---|---|---|---|---|---|---|
Univariable OR (95% CI) | Multivariable OR (95% CI) | Univariable OR (95% CI) | Multivariable OR (95% CI) | Univariable OR (95% CI) | Multivariable OR (95%CI) | |
Sex (female) | 0.40 (0.16–0.99)∆ | 0.20 (0.06–0.61)† | 0.10 (0.03–0.34)† | 0.08 (0.02–0.34)† | 0.17 (0.05–0.54)† | 0.12 (0.03–0.47)† |
Age | 1.01 (0.97–1.05) | – | 1.03 (0.97–1.08) | – | 0.99 (0.94–1.04) | – |
Diabetes | 3.90 (1.52–10.01)† | 6.46 (2.08–20.10)† | 5.58 (1.71–18.18)† | 7.19 (1.67–31.07)† | 8.00 (2.00–31.99)† | 11.21 (2.38–52.75)† |
Hypertension | 3.25 (0.99–10.74) | – | 3.03 (0.74–12.45) | – | 1.26 (0.40–3.99) | – |
Hyperlipidemia | 9.20 (1.14–74.25)* | – | 0.96 (0.28–3.22) | – | 0.44 (0.12–1.65) | – |
Renal dysfunction^ | 1.75 (0.33–9.27) | – | 4.50 (0.50–40.26) | – | 10.85 (1.24–94.97) * | – |