Prevalencija i kardiovaskularni ishodi kod dijabetičke kardiomiopatije u egipatskih bolesnika s dijabetesom tipa 2: presječna multicentrična studija u bolničkom okružju

A multicenter study to evaluate the prevalence and cardiovascular outcomes of diabetic cardiomyopathy in type II diabetic patients. Two hundred participants with type II diabetes mellitus (DM) were included, while participants with coronary artery disease (CAD), valvular heart disease, or history of alcohol or drug abuse were excluded. Participants were subjected to history taking for age, gender, body mass index, smoking, dyslipidemia, medications, DM, Framingham diagnostic criteria of heart failure (HF), comprehensive clinical examination, 12 leads resting electrocardiogram, transthoracic echocardiography and one of the following laboratory investigations: glycated hemoglobin, random blood sugar, fasting blood sugar, or 2-hour 75-gram oral glucose tolerance test. The prevalence of diabetic cardiomyopathy versus (vs) no diabetic cardiomyopathy, left ventricular (LV) diastolic dysfunction grade II and III, systolic dysfunction, and hypertrophy in the study population was 23.0% vs 77.0%, 18.5%, 5.0%, and 8.0%, respectively. There was a highly significant difference between LV diastolic dysfunction grade II and III, systolic dysfunction, and hypertrophy in the diabetic cardiomyopathy group vs no diabetic cardiomyopathy group, with an absolute risk increase of 80%, 22%, and 35% in the diabetic cardiomyopathy group, respectively. There was a highly significant difference between the mean ejection fraction (EF) in the diabetic cardiomyopathy group vs the no diabetic cardiomyopathy group. The mean EF for the diabetic cardiomyopathy group was 5.5% lower than the mean EF for the no diabetic cardiomyopathy group. The prevalence of HF and pre-clinical HF in the diabetic cardiomyopathy group was 65% and 35%, respectively. The mean age for HF was 4.1 years older than the mean age for pre-clinical HF in the diabetic cardiomyopathy group. Smoking was significantly and strongly associated with HF vs pre-clinical HF in the diabetic cardiomyopathy group. Diabetic cardiomyopathy was prevalent in an Egyptian type II diabetic patient population and could be considered a primary myocardial disease predisposing to HF in type II DM.
Cilj: Proveli smo multicentričnu studiju kako bismo odredili prevalenciju i kardiovaskularne ishode kod dijabetičke kardiomiopatije (DCM) u bolesnika s dijabetesom tipa 2. Metode: U istraživanje je bilo uključeno dvjesto ispitanika s dijabetesom tipa 2 (DM). Isključeni su ispitanici s koronarnom bolesti srca (CAD), valvularnom bolesti srca ili anamnestičkim podatcima o zlouporabi droga ili alkohola. Nakon anamnestičkih podataka utvrđeni su indeks tjelesne mase, učestalost pušenja, dislipidemije, DM-a, uporaba lijekova te su provedeni procjena dijagnostičkih kriterija zatajivanja srca (HF) prema Framinghamskoj studiji, klinički pregled, 12-kanaln elektrokardiogram u mirovanju, transtorakalna ehokardiografija te jedna od laboratorijskih varijabli: HbA1c, nasumične ili natašte izmjerene vrijednost glukoze u krvi ili rezultat dvosatnog testa oralne podnošljivosti glukoze. Rezultati: Prevalencija u usporedbi s odsutnošću DCM-a, dijastolička disfunkcija lijeve klijetke (LV) II. i III. stupnja, sistolička disfunkcija i hipertrofija u istraživanoj skupini iznosile su, redom: 23,0 % prema 77,0 %, 18,5 %, 5,0 % i 8,0 %. U skupini s DCMom postojala je značajna razlika u učestalosti dijastoličke disfunkcije LV-a II. i III. stupnja, sistoličke disfunkcije i hipertrofiji u usporedi sa skupinom ispitanika bez DCM-a, s apsolutnim povećanjem rizika u skupini s DCM-om za ta stanja od, redom, 80 %, 22 % i 35 %. Pronađena je i signifikantna razlika u prosječnoj vrijednosti ejekcijske frakcije (EF) između skupina s DCM-om i bez DCM-a. Prosječna EF u skupini s DCM-om bila je za 5,5 % niža nego u skupini bez DCM-a. Zastupljenost HF-a i pretkliničke HF u skupini s DCM-om iznosila je 65 % i 35 %. U skupni s DCM-om prosječna je dob kod HF-a bila 4 ,1 godinu viša nego prosječna dob za pretklinički HF. Pušenje je bilo izrazito i značajno povezano s HF-om u odnosu prema predkliničkom HF-u u skupni s DCM-om. Zaključci: DCM je bio zastupljen u egipatskih bolesnika s dijabetesom tipa 2 te se može smatrati primarnom miokardijalnom bolešću koja uzrokuje predispoziciju za HF kod dijabetesa tipa 2.