Early Changes In Cardiac Morphology,Function And Autonomic Neuropathy In Individuals With Type 2 Diabetes Mellitus

Objective:Cardiac and macrovascular complications are the leading cause of death in Type 2Diabetes Mellitus(T2DM)patients,except for coronary atherosclerotic heart disease(Coronary Artery Disease,CAD),diabetic myocardial microcirculation disorders,and abnormal myocardial metabolism.Diabetic Cardiomyopathy(DCM)and Diabetic Cardiovascular Autonomic Neuropathy(DAN)caused by multiple factors are important causes of heart disease in diabetic patients.The early manifestations of DCM include asymptomatic changes in left ventricular ejection fraction preserved cardiac structure and abnormal heart function.In the late stage,left ventricular ejection fraction decreased and obvious cardiac structure abnormalities may occur,leading to clinical heart failure symptoms.CAN usually manifests as resting tachycardia,orthostatic hypotension,asymptomatic myocardial ischemia,and prolonged QT interval.At present,the risk factors for abnormal cardiac structure and function of early diabetes in T2DM patients,and the interaction between DCM and DAN are still unclear.It has important clinical significance to analyze the abnormalities of early cardiac structure,function and cardiac autonomic nerve function in patients with T2DM through echocardiography(ECHO)and short-term heart rate variability(HRV).Methods:A retrospective collection of cases who were hospitalized in the Department of Endocrinology and Metabolism of the First People’s Hospital of Yunnan Province from September 1,2018 to December 30,2020,and joined the National Standardized Metabolic Management Center(Metabolic Management Center,MMC)management.By collecting ECHO,HRV,questionnaire survey,laboratory data.Uncomplicated coronary atherosclerotic heart disease,severe valvular heart disease(Valvular Heart Disease,VHD),myocardial ischemic changes in electrocardiogram,congenital heart disease(CHD),and other types except T2DM were included Diabetes and T2DM patients with Left Ventricular Ejection Fraction(LVEF)>0.5.Enrolled subjects were divided into hypertension(HT)group and non-hypertension group.According to ECHO results,they were divided into groups with normal left ventricular diastolic function,mild abnormalities,and moderate to severe abnormalities;according to the results of heart rate variability analysis,they were divided into combined DAN group And the unmerged DAN group.Using t test,analysis of variance,chi-square test,binary and multivariate Logistic regression,analyze the risk factors of DCM and DAN,the changes of cardiac structure and function in different groups,and analyze the correlation between DCM and DAN.It is considered that P<0.05 is statistically significant.Results:1.Among the enrolled T2DM patients,75 patients were combined with HT,and the prevalence rate of HT was 29.1%;patients with HT had diastolic dysfunction accounted for 65.3%(49/75),and patients without HT had diastolic function The disabled accounted for 53.6%(98/183),and there was a difference between the two(p=0.045).2.Among T2DM patients with normal blood pressure,53.6%(98/183)of patients with abnormal diastolic function.Among patients with abnormal cardiac dilatation,53.1%(52/98)were mildly abnormal,and 46.9%(46/98)were moderate-to-severe abnormalities.3.Among the enrolled T2DM patients,the prevalence of DCM was 17.8%(46/183).According to blood pressure and diastolic function,the enrolled patients were divided into normal blood pressure without left ventricular diastolic dysfunction(NDCM1),simple hypertension without left ventricular diastolic dysfunction(DMHT0),diabetic cardiomyopathy(DCM),hypertension Combined with left ventricular diastolic dysfunction group(DMHT1)four groups,age,sex are male,smoking,glycosylated hemoglobin,systolic blood pressure,diastolic blood pressure(p<0.05)are the risk factors,of which gender is male and increased systolic blood pressure is the risk factor.Independent risk factors.4.Among the enrolled T2DM patients,the prevalence of DAN was 36.4%(94/258).Age and course of disease are risk factors for DAN,and age(p<0.05)is an independent risk factor.5.Among T2DM patients without HT,the prevalence of DAN in the DCM group was41.3%(19/46);the prevalence of DAN in the NDCM group was 31.4%(43/137),and there was no significant difference between the two groups(p=0.239).The prevalence of DCM in the DAN group was 35.5%(22/62);the prevalence of DCM in the NDAN group was 28.9%(35/121).There was no significant difference between the two groups(p=0.229).6.In T2DM patients without HT,the left ventricular posterior wall thickness(LVPWT)of the DAN group was significantly higher than that of the NDAN group[25.6%(31/121)vs 38.7%(24/62),p =0.049],the low frequency(LF)of the DCM group was significantly lower than that of the NDCM group [47.4%(65/137)vs 63%(29/46),p=0.048].Conclusion:In T2DM patients with normal LVEF,the incidence of left ventricular diastolic dysfunction is higher.Gender and systolic blood pressure are independent risk factors.The independent risk factors for DAN in T2DM patients are age.Sympathetic nerve hyperexcitability exists in DCM patients,and LVPWT is increased in DAN patients,suggesting that there may be an interaction between cardiac structure,function and autonomic nerve function in T2DM patients.