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Cardiac Structural Remodeling, Longitudinal Systolic Strain, and Torsional Mechanics in Lean and Nonlean Dysglycemic Chinese Adults.
Circ Cardiovasc Imaging. 2018 05; 11(5):e007047.CC

Abstract

BACKGROUND

Diabetes mellitus and pre-diabetes mellitus are associated with lower body mass indices and increased risk of cardiovascular events (including heart failure) at lower glucose thresholds in Chinese compared with Western cohorts. However, the extent of cardiac remodeling and regulation on cardiac mechanics in lean and nonlean dysglycemic Chinese adults is understudied.

METHODS AND RESULTS

We studied 3950 asymptomatic Chinese (aged 49.7±10.7 years; 65% male; body mass index: 24.3±3.5 kg/m2) with comprehensive echocardiography including speckle tracking for left ventricular global longitudinal strain/torsion, with plasma sugar, glycosylated hemoglobin (HbA1c), and insulin resistance (homeostasis model assessment of insulin resistance) obtained. Participants were classified as (1) nondiabetic (fasting glucose <100 mg/mL; HbA1c <5.7%; n=1416), prediabetic (fasting glucose 100-126 mg/dL; HbA1c 5.7%-6.4%; n=2029), or diabetic (n=505) and (2) lean (body mass index <23 kg/m2; n=1445) or nonlean (n=2505). Higher sugar, HbA1c, and homeostasis model assessment of insulin resistance were independently associated with higher left ventricular mass, greater mass-to-volume ratio, more impaired diastolic indices, and worse global longitudinal strain even after adjusting for clinical covariates (adjusted coefficient value: 0.28/0.12 for global longitudinal strain per 1 U HbA1c/homeostasis model assessment of insulin resistance increment; both P<0.001), with a consistent trend toward greater torsion (all trend P<0.001). The optimal cutoffs in identifying subclinical systolic dysfunction (global longitudinal strain more impaired than -18%) for lean versus nonlean individuals were 97 versus 106 mg/dL for fasting sugar, 130 versus 135 mg/mL for postprandial sugar, 5.62% versus 6.28% for HbA1c, and 1.81 versus 2.40 for homeostasis model assessment of insulin resistance, respectively.

CONCLUSIONS

These data demonstrate the presence of preclinical cardiac remodeling and systolic dysfunction in prediabetic and diabetic Chinese adults, occurring at lower thresholds of glycemic indices than defined by international standards, particularly in lean individuals.

Authors+Show Affiliations

Department of Medicine, Mackay Medical College, New Taipei City, Taiwan (J.-L.L., K.-T.S., C.-H.S., C.-I.L., J.-P.T., S.-C.C., C.-L.H.). Division of Endocrinology and Metabolism, Department of Internal Medicine (J.-L.L.).Department of Medicine, Mackay Medical College, New Taipei City, Taiwan (J.-L.L., K.-T.S., C.-H.S., C.-I.L., J.-P.T., S.-C.C., C.-L.H.). Division of Cardiology, Department of Internal Medicine (K.-T.S., C.-H.S., C.-I.L., J.-P.T., C.-L.H., H.-I.Y.).Department of Medicine, Mackay Medical College, New Taipei City, Taiwan (J.-L.L., K.-T.S., C.-H.S., C.-I.L., J.-P.T., S.-C.C., C.-L.H.). Division of Cardiology, Department of Internal Medicine (K.-T.S., C.-H.S., C.-I.L., J.-P.T., C.-L.H., H.-I.Y.).No affiliation info availableDepartment of Medicine, Mackay Medical College, New Taipei City, Taiwan (J.-L.L., K.-T.S., C.-H.S., C.-I.L., J.-P.T., S.-C.C., C.-L.H.). Division of Cardiology, Department of Internal Medicine (K.-T.S., C.-H.S., C.-I.L., J.-P.T., C.-L.H., H.-I.Y.).Department of Medicine, Mackay Medical College, New Taipei City, Taiwan (J.-L.L., K.-T.S., C.-H.S., C.-I.L., J.-P.T., S.-C.C., C.-L.H.). Division of Cardiology, Department of Internal Medicine (K.-T.S., C.-H.S., C.-I.L., J.-P.T., C.-L.H., H.-I.Y.).Department of Medicine, Mackay Medical College, New Taipei City, Taiwan (J.-L.L., K.-T.S., C.-H.S., C.-I.L., J.-P.T., S.-C.C., C.-L.H.).MacKay Memorial Hospital, Taipei, Taiwan. Division of Cardiology, Department of Internal Medicine, Hsinchu MacKay Memorial Hospital, Hsinchu City, Taiwan (Y.-H.L.).Health Evaluation Center (K.-C.H., C.-Y.L.). Division of Gastroenterology, Department of Internal Medicine (K.-C.H., C.-Y.L.).Health Evaluation Center (K.-C.H., C.-Y.L.). Division of Gastroenterology, Department of Internal Medicine (K.-C.H., C.-Y.L.).Health Evaluation Center (K.-C.H., C.-Y.L.). and Department of Radiology (C.-H.Y.).Department of Medicine, Mackay Medical College, New Taipei City, Taiwan (J.-L.L., K.-T.S., C.-H.S., C.-I.L., J.-P.T., S.-C.C., C.-L.H.). jotaro3791@gmail.com. Division of Cardiology, Department of Internal Medicine (K.-T.S., C.-H.S., C.-I.L., J.-P.T., C.-L.H., H.-I.Y.). Institute of Clinical Medicine (C.-L.H.). and Cardiovascular Research Center (C.-L.H.).Division of Cardiology, Department of Internal Medicine (K.-T.S., C.-H.S., C.-I.L., J.-P.T., C.-L.H., H.-I.Y.).National Yang-Ming University, Taipei, Taiwan. National Heart Centre Singapore (C.S.P.L.). Duke-National University of Singapore (C.S.P.L.).

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

29752393

Citation

Lin, Jiun-Lu, et al. "Cardiac Structural Remodeling, Longitudinal Systolic Strain, and Torsional Mechanics in Lean and Nonlean Dysglycemic Chinese Adults." Circulation. Cardiovascular Imaging, vol. 11, no. 5, 2018, pp. e007047.
Lin JL, Sung KT, Su CH, et al. Cardiac Structural Remodeling, Longitudinal Systolic Strain, and Torsional Mechanics in Lean and Nonlean Dysglycemic Chinese Adults. Circ Cardiovasc Imaging. 2018;11(5):e007047.
Lin, J. L., Sung, K. T., Su, C. H., Chou, T. H., Lo, C. I., Tsai, J. P., Chang, S. C., Lai, Y. H., Hu, K. C., Liu, C. Y., Yun, C. H., Hung, C. L., Yeh, H. I., & Lam, C. S. P. (2018). Cardiac Structural Remodeling, Longitudinal Systolic Strain, and Torsional Mechanics in Lean and Nonlean Dysglycemic Chinese Adults. Circulation. Cardiovascular Imaging, 11(5), e007047. https://doi.org/10.1161/CIRCIMAGING.117.007047
Lin JL, et al. Cardiac Structural Remodeling, Longitudinal Systolic Strain, and Torsional Mechanics in Lean and Nonlean Dysglycemic Chinese Adults. Circ Cardiovasc Imaging. 2018;11(5):e007047. PubMed PMID: 29752393.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cardiac Structural Remodeling, Longitudinal Systolic Strain, and Torsional Mechanics in Lean and Nonlean Dysglycemic Chinese Adults. AU - Lin,Jiun-Lu, AU - Sung,Kuo-Tzu, AU - Su,Cheng-Huang, AU - Chou,Tzu-Hsun, AU - Lo,Chi-In, AU - Tsai,Jui-Peng, AU - Chang,Shun-Chuan, AU - Lai,Yau-Huei, AU - Hu,Kuang-Chun, AU - Liu,Chia-Yuan, AU - Yun,Chun-Ho, AU - Hung,Chung-Lieh, AU - Yeh,Hung-I, AU - Lam,Carolyn S P, PY - 2017/08/17/received PY - 2018/03/26/accepted PY - 2018/5/13/entrez PY - 2018/5/13/pubmed PY - 2019/8/14/medline KW - cardiomyopathy KW - diabetes mellitus KW - glucose KW - heart failure KW - insulin resistance SP - e007047 EP - e007047 JF - Circulation. Cardiovascular imaging JO - Circ Cardiovasc Imaging VL - 11 IS - 5 N2 - BACKGROUND: Diabetes mellitus and pre-diabetes mellitus are associated with lower body mass indices and increased risk of cardiovascular events (including heart failure) at lower glucose thresholds in Chinese compared with Western cohorts. However, the extent of cardiac remodeling and regulation on cardiac mechanics in lean and nonlean dysglycemic Chinese adults is understudied. METHODS AND RESULTS: We studied 3950 asymptomatic Chinese (aged 49.7±10.7 years; 65% male; body mass index: 24.3±3.5 kg/m2) with comprehensive echocardiography including speckle tracking for left ventricular global longitudinal strain/torsion, with plasma sugar, glycosylated hemoglobin (HbA1c), and insulin resistance (homeostasis model assessment of insulin resistance) obtained. Participants were classified as (1) nondiabetic (fasting glucose <100 mg/mL; HbA1c <5.7%; n=1416), prediabetic (fasting glucose 100-126 mg/dL; HbA1c 5.7%-6.4%; n=2029), or diabetic (n=505) and (2) lean (body mass index <23 kg/m2; n=1445) or nonlean (n=2505). Higher sugar, HbA1c, and homeostasis model assessment of insulin resistance were independently associated with higher left ventricular mass, greater mass-to-volume ratio, more impaired diastolic indices, and worse global longitudinal strain even after adjusting for clinical covariates (adjusted coefficient value: 0.28/0.12 for global longitudinal strain per 1 U HbA1c/homeostasis model assessment of insulin resistance increment; both P<0.001), with a consistent trend toward greater torsion (all trend P<0.001). The optimal cutoffs in identifying subclinical systolic dysfunction (global longitudinal strain more impaired than -18%) for lean versus nonlean individuals were 97 versus 106 mg/dL for fasting sugar, 130 versus 135 mg/mL for postprandial sugar, 5.62% versus 6.28% for HbA1c, and 1.81 versus 2.40 for homeostasis model assessment of insulin resistance, respectively. CONCLUSIONS: These data demonstrate the presence of preclinical cardiac remodeling and systolic dysfunction in prediabetic and diabetic Chinese adults, occurring at lower thresholds of glycemic indices than defined by international standards, particularly in lean individuals. SN - 1942-0080 UR - https://www.unboundmedicine.com/medline/citation/29752393/Cardiac_Structural_Remodeling_Longitudinal_Systolic_Strain_and_Torsional_Mechanics_in_Lean_and_Nonlean_Dysglycemic_Chinese_Adults_ DB - PRIME DP - Unbound Medicine ER -