Effect of glycemic status on myocardial deformation and microvascular function in uncomplicated pediatric type 1 diabetes mellitus: cardiac magnetic resonance imaging.
Lu Zhang, Shan Huang, Xueming Li, Zhi Yang, Pengfei Ye, Ran Sun, Huayan Xu, Rong Xu, Meng Zhang, Ying Liu, Chuanjie Yuan, Jin Wu, Yingkun Guo
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引用次数: 0
Abstract
Background: Cardiovascular disease remains the leading cause of morbidity and mortality among individuals with type 1 diabetes mellitus (T1DM). Individuals with hyperglycemia are at great risk of cardiovascular complications. This study investigated the impact of glycemic control on left ventricular (LV) microvascular perfusion and myocardial deformation in uncomplicated pediatric T1DM using cardiac magnetic resonance (CMR) imaging.
Methods: A total of 100 uncomplicated pediatric patients with T1DM and 35 controls were enrolled and underwent 3.0 T CMR examinations. Patients were divided into two groups according to HbA1c levels of 7.0% (HbA1c < 7.0%, n = 25; HbA1c ≥ 7.0%, n = 75). Subclinical systolic and diastolic function were evaluated using peak strain and strain rate based on myocardial deformation analysis. Myocardial perfusion upslope and maximum signal intensity (MaxSI) were assessed via first-pass perfusion imaging at rest. Multivariable linear regression analyses identified the independent factors of reduced myocardial perfusion and deformation in T1DM patients.
Results: Among the three groups, longitudinal peak diastolic strain rate (PDSR) deteriorated gradually from controls through patients with HbA1c < 7.0% to patients with HbA1c ≥ 7.0% (all p < 0.05). Upslope in patients with HbA1c ≥ 7.0% was decreased compared to patients with HbA1c < 7.0% (p = 0.007) and controls (p < 0.001). Compared to controls, both MaxSI and circumferential PDSR were reduced in patients with HbA1c ≥ 7.0% (p = 0.025 and 0.016, respectively), but not in patients with HbA1c < 7.0% (p = 0.566 and 0.379, respectively). In multivariable analysis, elevated HbA1c level was independently associated with reduced upslope (β = - 2.53, p < 0.001) and longitudinal PDSR (β = - 0.02, p = 0.007). When the perfusion indices were included in the multivariable analysis for diastolic dysfunction, upslope (β = 0.10, p = 0.016) and MaxSI (β = - 0.02, p = 0.006) were associated with reduced longitudinal PDSR.
Conclusion: Pediatric T1DM with higher HbA1c showed worse myocardial perfusion and subclinical diastolic dysfunction. Microvascular dysfunction was associated independently with cardiac dysfunction.
背景：心血管疾病仍然是1型糖尿病（T1DM）患者发病和死亡的主要原因。高血糖患者发生心血管并发症的风险很大。本研究利用心脏磁共振（CMR）成像技术探讨血糖控制对无并发症儿童T1DM患者左室微血管灌注和心肌变形的影响。方法：选取100例无并发症的T1DM患儿和35例对照组，进行3.0 T CMR检查。根据HbA1c水平7.0%将患者分为两组（HbA1c）结果：三组患者中，纵向峰值舒张应变率（PDSR）从对照组到HbA1c患者逐渐恶化结论：HbA1c较高的儿童T1DM患者心肌灌注更差，亚临床舒张功能障碍更严重。微血管功能障碍与心功能障碍独立相关。试验注册：回顾性注册ChiCTR2100043799。
期刊介绍：
Cardiovascular Diabetology is a journal that welcomes manuscripts exploring various aspects of the relationship between diabetes, cardiovascular health, and the metabolic syndrome. We invite submissions related to clinical studies, genetic investigations, experimental research, pharmacological studies, epidemiological analyses, and molecular biology research in this field.
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