Study On Prevention And Treatment Strategies Of Type 2 Diabetic Cardiomyopathy Based On Metabolic Factors And Cardiac Ultrasound

Part I The prevalence of early left ventricular diastolicdysfunction in type 2 diabetic cardiomyopathy,control ofmetabolic factors and diagnostic modelsBackground: As a major public health problem in China,the prevalence of type2 diabetes mellitus has been increasing year by year in recent years,and diabetic cardiomyopathy is one of the important chronic complications of type 2 diabetes mellitus and a major cause of death.Our aim was to explore the prevalence,control of metabolic factors and clinical disease correlates of left ventricular diastolic dysfunction in patients with type 2 diabetes and to develop a predictive diagnostic model.Methods: The clinical data of patients with type 2 diabetes mellitus with complete medical records were extracted from patients registered for hospitalization at Zhongda Hospital,Southeast University from 2013 to 2018,and 7,112 patients(3,601 males,3,511 females)were included after exclusion.The prevalence of standardized left ventricular diastolic dysfunction obtained from the 2010 national census data of China was weighted to account for the control of metabolic factors and clinical disease correlates of left ventricular diastolic dysfunction in the population.After using propensity score matching,3496 patients(1960 males and 1536 females)were finally included for column line graph model calculation and webpage diagnostic model.Results: The prevalence of left ventricular diastolic dysfunction was 61.9%(95%CI,58.6%-65.1%)in patients with type 2 diabetes,with a prevalence of 60.3%(95%CI,57.5%-63.1%)in men and 63.9%(95% CI,61.2%-66.6%)in women.In addition,more than 64% of men and 65% of women had substandard Hb A1 c control;the prevalence of hypercholesterolaemia was 9.9%(95% CI,9.6%-10.2%)、hypertriglyceridaemia 25.1%(95% CI,24.6%-25.6%)、low HDL-cholesterolaemia35.6%(95% CI,35.1%-36.1%),and 11.4%(95% CI,11.0%-11.7%)for high LDLcholesterolaemia.After propensity score matching,the study identified duration of diabetes,pulse pressure,creatinine value,antithrombin III,and fibrinogen as independent risk factors and developed a dynamic line graph diagnostic model based on these indicators.Conclusion: As one of the early features of diabetic cardiomyopathy,the prevalence of left ventricular diastolic dysfunction in Chinese patients with type 2diabetes is high and correlates significantly with other clinical conditions.Therefore,a diagnostic model could be developed to better identify early features and populations of type 2 diabetic cardiomyopathy.Part II Strategies for early diabetic cardiomyopathy prevention in Chinese patients with type 2 diabetes based on cluster analysisBackground: Type 2 diabetes may impair cardiac structure and function at very early stage,other factors,for example,obesity and hypertension,can induce aforementioned abnormalities individually.This study aimed to explore precise prevention and treatment of diabetic cardiomyopathy by using cluster analysis of echocardiographic variables.Methods: A total of 66 536 inpatients with diabetes from 2013 to 2018 were investigated,and 7112 patients were available for analysis after nadir.The cluster analysis was performed on echocardiographic variables to assess the clinical profiles and risk factors of clusters.Results: Two clusters were identified.Cluster 1 with 3576 patients(50.3%,including 62.5% female)had hypertension in 62.4%,while the lower rate of obesity(13.7%).Ultrasound findings showed that 79.9% of them had left ventricular diastolic dysfunction(LVDD),the most characteristic change in the early stages of DCM.Systolic blood pressure(SBP),uric acid and antithrombin III were independent risk factors for LVDD(P < 0.0001);64.0% of the 3536 patients in the second group were male,with a high prevalence of obesity(30.1%)and a higher prevalence of hypertension(79.5%),In particular,decreased systolic function and a high rate of LV hypertrophy(46.8%)represented the progressive phase of DCM(P < 0.0001).SBP,diastolic blood pressure,BMI and creatinine were independent correlates of LV mass index(P < 0.05).Conclusion: The cluster analysis of echocardiographic variables may better identify people with similar risk and different disease courses of diabetic cardiomyopathy and will certainly facilitate more targeted early prevention and treatment of diabetic cardiomyopathy.