SCI 발표논문

SCI 발표논문

← SCI 발표논문 목록

Sci Rep. 2021;11(1):11664.

Sex-specific impact of diabetes mellitus on left ventricular systolic function and prognosis in heart failure.

, , , , ,

제1저자 곽순구 · 교신저자 박준빈, 조구영

PMID 34083601 PMC8175704 DOI 10.1038/s41598-021-91170-x IF 4.9 순환기내과
소속 (8)
  1. Department of Internal Medicine, College of Medicine, Seoul National University, Daehak-ro 101, Jongno-gu, Seoul, 03080, Republic of Korea.
  2. Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea.
  3. Department of Cardiology, Cardiovascular Center, Bundang Hospital, Seoul National University, Gumiro 166, Bundang, Seongnam, Gyeonggi-do, Republic of Korea.
  4. Department of Cardiology in Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Republic of Korea.
  5. Department of Internal Medicine, College of Medicine, Seoul National University, Daehak-ro 101, Jongno-gu, Seoul, 03080, Republic of Korea. nanumy1@gmail.com.
  6. Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea. nanumy1@gmail.com.
  7. Department of Internal Medicine, College of Medicine, Seoul National University, Daehak-ro 101, Jongno-gu, Seoul, 03080, Republic of Korea. cardioch@snu.ac.kr.
  8. Department of Cardiology, Cardiovascular Center, Bundang Hospital, Seoul National University, Gumiro 166, Bundang, Seongnam, Gyeonggi-do, Republic of Korea. cardioch@snu.ac.kr.

Abstract

We aimed to investigate the sex differences in associations of diabetes mellitus (DM) with echocardiographic phenotypes and clinical outcomes of heart failure (HF). We studied 4,180 patients admitted for acute HF between 2009 and 2016 (median follow-up, 31.7 months) whose left ventricular global longitudinal strain (LV-GLS) data were available. Patients were compared by sex and DM. Structural equation model (SEM) analysis was performed to evaluate the moderating effects of two causal paths, via ischemic heart disease (IHD) and LV-GLS, linking DM with mortality. Compared to non-diabetic women, diabetic women had significantly lower LV-GLS (11.3% versus 10.1%, p < 0.001), but the difference was attenuated within men (9.7% versus 9.2%, p = 0.014) (p-for-interaction by sex = 0.018). In Cox analyses, DM was an independent predictor for higher mortality in both sexes (women: adjusted hazard ratio [HR] 1.35, 95% confidence interval [CI] 1.15-1.59 versus men: HR 1.24, 95% CI 1.07-1.44, p-for-interaction by sex = 0.699). Restricted cubic spline curves showed that LV-GLS consistently declined, and mortality increased in women with worsening hyperglycemia, but these trends were not evident in men. In SEM analysis, the main driver from DM to mortality differed by sex; men had a stronger effect via IHD than LV-GLS, whereas LV-GLS was the only predominant path in women.

Figures

Figure 1
Figure 1 Sex-related differences in the impact of DM on phenotypes, LV-GLS, and causal associations in HF. The main findings of the study are summarized. (Left) Diabetic men and women with HF had different clinical and echocardiographic phenotypes. (Middle) The associations of presentation blood glucose level with the LV-GLS impairment were more pronounced in women. In the RCS curves, LV-GLS continually declined as hyperglycemia became severe in women, while it reached a plateau in men, resulting in the gradual convergence of the two curves. (Right) The main driver from DM to mortality differed; men had a larger effect via IHD than LV-GLS impairment, whereas effect mediating LV-GLS was the only predominant path in women. Dominant pathways are indicated by bold arrows; those with dashes arrows are statistically insignificant. DM = diabetes mellitus; HF = heart failure; IHD = ischemic heart disease; LV-GLS = left ventricular global longitudinal strain; RCS = restricted cubic spline.
Figure 2
Figure 2 Kaplan–Meier curves for 5-year all-cause mortality according to sex and DM.
Figure 3
Figure 3 Sex-specific association of presentation glucose level with mortality risk and LV-GLS. (a) The graph shows the adjusted hazard ratios (solid lines) and 95% confidence intervals (dashed lines and shaded area) for the association between presentation glucose level and 5-year mortality in men (blue) and women (red). The glucose level was modeled with RCS in Cox models. The reference of glucose level was set at 125 mg/dL for hazard ratios estimation. Density plots show the distribution of patients according to the glucose level. (b) RCS curves were plotted between presentation glucose level and LV-GLS. Each dot indicates an individual patient’s data. LV-GLS = left ventricular global longitudinal strain, RCS = restricted cubic spline.
Figure 4
Figure 4 Path diagrams of relationship between DM, LV-GLS or IHD, and mortality by sex. Diagrams of the structural equation model in men (a) and women (b). Standardized path coefficients are shown on each path as effect estimates. Solid lines denote significant paths and dashed lines, non-significant paths. 5-year mortality data was used. DM = diabetes mellitus; IHD = ischemic heart disease; LV-GLS = left ventricular global longitudinal strain. *p < 0.05, **p < 0.001.

그림 출처: PubMed Central 공개 논문 (PMC8175704)

Conflict of interest statement

The authors declare no competing interests.

그 밖의 정보
출판 형태
Journal Article, Research Support, Non-U.S. Gov't
저널
Scientific reports · eISSN 2045-2322
전자 출판
2021-06-03
MeSH
Aged · Aged, 80 and over · Biomarkers · Blood Glucose · Diabetes Complications / epidemiology · Echocardiography · Female · Heart Failure / diagnosis / epidemiology / etiology / physiopathology · Heart Function Tests · Humans · Kaplan-Meier Estimate · Male · Middle Aged · Mortality · Prognosis · Risk Assessment · Risk Factors · Sex Factors · Ventricular Dysfunction, Left / diagnosis / epidemiology / etiology
Substances
Biomarkers · Blood Glucose
참고문헌
31편