First Author: Y.Chung SOUTH KOREA
Co Author(s): S. Park H. Lim K. Lee
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The presence of diabetic retinopathy (DR) in diabetic patients suggests that microvascular complications are manifested clinically. Dilated cardiomyopathy (dCMP) is defined by the presence of left ventricular systolic dysfunction in the absence of an abnormal loading condition or significant coronary artery disease. The exact pathophysiological mechanisms are still under investigation, while oxidative stress, activation of the renin-angiotensin system, and altered substrate metabolism have been suggested as possible contributors to the pathogenesis. Since these mechanisms share common pathways with diabetic microvascular complications, we investigated the association between DR and myocardial dysfunction in type 2 diabetic patients with dCMP.
We performed a retrospective clinical study to investigate the association of diabetes or DR with myocardial function in patients with type 2 diabetes and non-ischaemic dCMP compared with that in patients without diabetes.
The medical records of patients diagnosed with non-ischaemic dCMP between 1994 and 2015 and followed by the Ophthalmology and Cardiology departments of Ajou University Hospital (Suwon, Korea) were retrospectively reviewed. Data were collected from 89 patients with dCMP (46 with type 2 diabetes and 43 without diabetes) and no evidence of coronary artery disease. Demographic and clinical factors were obtained from medical records: age, gender, body mass index, general medical illness, presence of diabetes and DR, serum lipid profile, estimated glomerular filtration rate (eGFR), and medications including anticoagulants, β-blockers, angiotensin-converting enzyme inhibitor, angiotensin receptor blocker, calcium channel blocker, diuretics and statins. Echocardiographic parameters and laboratory data, including lipid profiles and fundus findings, were also obtained from medical records. A left ventricular ejection fraction (LVEF) less than 40% was considered impaired systolic function, while an E/E’ ratio (left ventricular filling pressures) greater than 15 was considered impaired diastolic function. Categorical variables were compared using the chi-square test, and continuous variables were compared using independent t-test or Mann-Whitney test. Logistic regression analysis was performed to evaluate factors associated with impaired systolic or diastolic function.
In the laboratory profile, creatinine was increased in patients with diabetes, and eGFR was decreased in these patients. Hypertension was more common in patients with diabetes, while the use of statins was also more frequent in patients with diabetes. A subgroup analysis of the patients with diabetes was also performed, and 29 patients had DR, and 17 did not have DR. The creatinine levels were significantly higher in the patients with DR, while eGFR was higher in the patients without DR. Total cholesterol and the levels of HDL cholesterol were higher in patients without DR. LVEF was not significantly different between patients with and without diabetes or between diabetic patients with and without DR. Among the diastolic function parameters, patients with DR exhibited higher E/E’ ratios than patients without DR (P = 0.022). Logistic regression analysis revealed that statin use lowered the risk of impaired systolic dysfunction in all patients (P = 0.034) and in patients with diabetes (P = 0.049), while the presence of DR was associated with a higher risk of diastolic dysfunction in patients with diabetes (P = 0.023).
DR was associated with diastolic dysfunction in patients with diabetes and non-ischaemic dCMP. DR may represent a widespread systemic microcirculation disease in diabetic patients, which leads to an increased load for the heart and compromises cardiac performance.