Cardiac Structural And Functional Features In Type 2 Diabetes Mellitus Related Heart Failure With Preserved Ejection

Objective:Based on propensity score matching,the characteristics of cardiac structural and functional impairment in heart failure with preserved ejection fraction and concomitant type 2 diabetes mellitus were studied and its influencing factors were analyzed.Methods:A total of 783 consecutive heart failure patients with preserved ejection fraction(HFp EF)was enrolled in the geriatric Cardiovascular Department of a hospital of Lanzhou University from April 2009 to December 2020,and echocardiography and tissue Doppler techniques were employed for evaluating cardiac structure and function.According to whether they were complicated with type 2 diabetes mellitus(T2DM),they were divided into HFp EF+T2DM group(n=332)and HFp EF group(n=451).Propensity score matching was used to balance the cofounders among the groups.HFp EF+T2DM group was further divided into three subgroups according to urinary microalbumin excretion rate(UAER,<20mg/min,20～200mg/min,and>200mg/min).The comorbidities,severities of the symptom and signs,and cardiac structure and function were compared among the groups to clarify the features of diabetes related HFp EF.Multiple linear regression was conducted to probe the relationship of systolic blood pressure,glucose,glycosylated hemoglobin(Hb A1c),and UARE with cardiac structural and functional impairment.Results:1.Of 783 patients with HFp EF,332(42.4%)had a history of T2DM with a course of 10(3,17)years.Compared with HFp EF group,the prevalence of hypertension(P=0.001)and coronary vascular diseases(P=0.036)was higher in HFp EF+T2DM group,furthermore,HFp EF+T2DM had younger age(P=0.020)、larger body mass index(P=0.005)and larger waist-to-hip ratio(P<0.001).After PSM,the prevalence of comorbidities,waist-to-hip ratio,body mass index,and age were similar between in the two groups,and there were no significant differences.2.In HFp EF+T2DM group,systolic blood pressure(P<0.001)was higher,water and sodium leakage symptoms such as lung rale(P=0.004)and peripheral edema(P=0.024)were more obvious.Fasting blood glucose(P<0.001),HA1bc(P<0.001),triglyceride(P<0.001),low density lipoprotein cholesterol(P=0.032),N-terminal pro-B-type natriuretic peptide(NT-pro BNP,P=0.043)and natural logarithm of urinary microalbumin excretion rate(ln UAER,P<0.001)in HFp EF+T2DM group were higher than those in HFp EF+T2DM group,while serum albumin(P=0.003)and high density lipoprotein cholesterol(P=0.007)were lower than those in HFp EF group.3.In HFp EF+T2DM group,interventricular septal thickness at end-diastole(IVSTd,P=0.015),posterior wall thickness at end-diastole(PWTd,P=0.040),relative wall thickness(RWT,P=0.022),left ventricular mass(LVM,P=0.012),left ventricular mass index(LVMi,P=0.045),ratio of(E)to late(A)mitral valve flow velocity(E/A,P=0.004),the ratio of E with e’of lateral(E/e’_L,P=0.022),the ratio of E with e’of septal(E/e’_S,P=0.022),ratio of transtitral doppler to annular tissue doppler early diastolic velocities(E/e’,P=0.036)were higher than those in HFp EF+T2DM group,while peak early diastolic lateral mitral annual velocity(e’_L,P=0.011),maximum velocity of the septum of the mitral compartment in early diastolic(e’_S,P=0.030)were lower than those in HFp EF group.4.In UAER>200mg/min subgroup,PWTd(P=0.041),LVM(P=0.044),LVMi(P=0.032),E/e’_L(P<0.001),E/e’_S(P<0.001),E/e’(P<0.001)were greater than UAER 20～200mg/min and UAER>200mg/min subgroup,and e’_L(P=0.001),e’_S(P=0.011)are less than the other two groups.5.Hb A1c with LVM(P=0.007)and LVMi(P=0.011),furthermore,natural logarithm of urinary microalbumin excretion rate(ln UAER)wih most of impaired left ventricular structural and functional parameters correlated independently,such as IVSTd(P=0.004),PWTd(P=0.006),LVM(P<0.001),LVMi(P<0.001),e’_L(P=0.021),E/e’_L(P=0.042),E/e’_S(P=0.042)and E/e’(P=0.049).Conclusions:1.T2DM related HFp EF shows thicker left ventricular wall and larger left ventricular mass,more advanced left ventricular remodeling compared with HFp EF without diabetes.2.T2DM related HFp EF shows more severely impaired left ventricular diastolic function with higher left ventricular filling pressure compared with HFp EF without diabetes.3.Elevated blood glucose and Diabetic microvascular diseases might play key roles in the development of those detrimental structural and functional changes.