T2DM合并高血压患者心肌环向应变与10年心血管病风险的关系

Relationship between myocardial circumferential strain and 10-year risk of cardiovascular disease in type 2 diabetic patients with hypertension

目的探讨2型糖尿病(T2DM)合并高血压患者左心室心肌环向应变与10年心血管病风险的关系。方法收集T2DM患者83例,以是否合并高血压分为糖尿病组(DM组)和糖尿病合并高血压组(DM+HBP组),选取同期住院患者54例为对照组。依据Framingham危险评分量表计算危险评分(FRS)和10年心血管病风险(10y CVDR)。分别获取左心室结构、功能和心肌环向应变参数,包括室间隔厚度(IVSD)、左心室后壁厚度(LVPWD)、左心室射血分数(LVEF)、左心室心内膜下心肌整体环向应变(GCS_(endo))、中层心肌整体环向应变(GCS_(mid))和心外膜下心肌整体环向应变(GCS_(epi))。心肌应变参数的组间比较采用方差分析,其与影响因素的关系采用Pearson相关分析和多元线性回归分析。根据10y CVDR值,分为低风险(<10%)和高风险(≥10%)两组,应用ROC曲线分析GCS_(endo)、GCS_(mid)和GCS_(epi)判断2型糖尿病患者发生10年心血管病风险的能力。结果Framingham危险评分在DM+HBP组、DM组和对照组依次降低,中位数分别为14、12和10(均P<0.05);对应10年心血管病风险的中位数分别为7%、5%和2%,DM+HBP组和DM组均高于对照组(均P<0.05)。与DM和对照组比,DM+HBP组受试者IVSD和LVPWD较厚,左心室舒张功能指标E/e较大(均P<0.05)。DM+HBP组和DM组GCS_(endo)、GCS_(mid)及GCS_(epi)均小于对照组(均P<0.01),而DM+HBP组与DM组间差异无统计学意义(P>0.05)。舒张压是GCS_(endo)、GCS_(mid)和GCS_(epi)正的独立影响因素(β=0.258、0.285和0.279,均P<0.05),而收缩压是其负的独立影响因素(β=-0.399、-0.449和-0.480,均P<0.05)。GCS_(endo)、GCS_(mid)和GCS_(epi)判断T2DM患者10年心血管病风险的ROC曲线下面积(95%CI)分别为0.701(0.5720.830)、0.691(0.5670.815)和0.677(0.5510.803),其灵敏度和特异度分别为66.7%和74.6%、87.5%和49.2%、87.5%和44.1%。结论T2DM合并高血压患者的心肌环向应变减低,这与血压独立相关;心肌环向应变能判断T2DM患者未来10年发生心血管病风险。

Objective To investigate the relationship between left ventricular myocardial circu-mferential strain and 10-year risk of cardiovascular disease in type 2 diabetes mellitus(T2DM)patients with hypertension.Methods A total of 83 patients with T2DM were enrolled in this study,including 57 cases with T2DM only(DM group)and 26 cases of T2DM with hypertension(DM+HBP group);and 54 healthy subjects served as the control group.The scores of the 10-year cardiovascular disease risk(10y CVDR)were calculated according to The Framingham Risk Scale(FRS).The parameters of LV structure:interventricular septal thickness(IVSD),LV posterior wall thickness(LVPWD),LV ejection fraction(LVEF),and LV global systolic circumferential strain in endocardium(GCS_(endo)),global systolic circumferential strain in mid-cardium(GCS_(mid))and global systolic circumferential strain in epicardium(GCS_(epi))were measured.Intergroup comparisons of myocardial strain parameters were analyzed by variance analysis,and risk factors were analyzed by Pearson correlation analysis and multiple linear regression analysis.The 10y CVDR values were used to divide the groups into low risk(<10%)and high risk(≥10%).The predictive values of GCS_(endo),GCS_(mid),and GCS_(epi)to identify patients with T2DM for 10y CVDR were evaluated by ROC curves.Results The median Framingham risk scores of the DM+HBP,DM,and control groups were 14,12 and 10,respectively(all P<0.05),and the corresponding median 10y CVDR were 7%,5%and 2%respectively.Compared with DM and control groups,the DM+HBP group had the thicker IVSD and LVPWD and the greater LV diastolic function index E/e(all P<0.05).In both the DM+HBP and DM groups,GCS_(endo),GCS_(mid),and GCS_(epi)were less than those in the control group(all P<0.01),while the differences between the DM+HBP and DM groups were not statistically significant(all P>0.05).Diastolic blood pressure was a positive independent risk factor of GCS_(endo),GCS_(mid),and GCS_(epi)(β=0.258,0.285 and 0.279,all P<0.05),while systolic blood pressure was a negative independent risk factor(β=-0.399,-0.449 and-0.480,all P<0.05).The area under the ROC curve(95%CI)for identifying the 10y CVDR in patients with T2DM by GCS_(endo),GCS_(mid)and GCS_(epi)was 0.701(0.572-0.830),0.691(0.567-0.815)and 0.677(0.551-0.803)respectively,with sensitivity of 66.7%,87.5%and 87.5%and specificity of 74.6%,49.2%and 44.1%,respectively.Conclusion Myocardial circumferential strain is reduced in T2DM patients with hypertension,which is independently associated with blood pressure.Myocardial circumferential can identify patients with T2DM at risk of cardiovascular disease in 10 years.