BACKGROUND Diabetes mellitus (DM) is associated with increased risk of cardiovascular disease. Detection of early cardiac changes before manifest disease develops is important. We investigated early alterations in cardiac structure and function associated with DM using cardiovascular magnetic resonance imaging. METHODS Participants from the UK Biobank Cardiovascular Magnetic Resonance Substudy, a community cohort study, without known cardiovascular disease and left ventricular ejection fraction ≥50% were included. Multivariable linear regression models were performed. The investigators were blinded to DM status. RESULTS A total of 3984 individuals, 45% men, (mean [SD]) age 61.3 (7.5) years, hereof 143 individuals (3.6%) with DM. There was no difference in left ventricular (LV) ejection fraction (DM versus no DM; coefficient [95% CI]: -0.86% [-1.8 to 0.5]; P=0.065), LV mass (-0.13 g/m2 [-1.6 to 1.3], P=0.86), or right ventricular ejection fraction (-0.23% [-1.2 to 0.8], P=0.65). However, both LV and right ventricular volumes were significantly smaller in DM, (LV end-diastolic volume/m2: -3.46 mL/m2 [-5.8 to -1.2], P=0.003, right ventricular end-diastolic volume/m2: -4.2 mL/m2 [-6.8 to -1.7], P=0.001, LV stroke volume/m2: -3.0 mL/m2 [-4.5 to -1.5], P<0.001; right ventricular stroke volume/m2: -3.8 mL/m2 [-6.5 to -1.1], P=0.005), LV mass/volume: 0.026 (0.01 to 0.04) g/mL, P=0.006. Both left atrial and right atrial emptying fraction were lower in DM (right atrial emptying fraction: -6.2% [-10.2 to -2.1], P=0.003; left atrial emptying fraction:-3.5% [-6.9 to -0.1], P=0.043). LV global circumferential strain was impaired in DM (coefficient [95% CI]: 0.38% [0.01 to 0.7], P=0.045). CONCLUSIONS In a low-risk general population without known cardiovascular disease and with preserved LV ejection fraction, DM is associated with early changes in all 4 cardiac chambers. These findings suggest that diabetic cardiomyopathy is not a regional condition of the LV but affects the heart globally.

中文翻译：

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糖尿病患者心脏形态和功能的变化：英国生物银行心血管磁共振子研究。

背景技术糖尿病(DM)与心血管疾病的风险增加相关。在明显疾病发生之前检测早期心脏变化非常重要。我们使用心血管磁共振成像研究了与 DM 相关的心脏结构和功能的早期改变。方法 纳入来自英国生物银行心血管磁共振亚组研究（一项社区队列研究）、无已知心血管疾病且左心室射血分数≥50%的参与者。进行了多变量线性回归模型。研究人员对 DM 状况不知情。结果 共有 3984 人，其中 45% 为男性，（平均 [SD]）年龄 61.3 (7.5) 岁，其中 143 人 (3.6%) 患有 DM。左心室 (LV) 射血分数（DM 与非 DM）没有差异；系数 [95% CI]：-0.86% [-1.8 至 0.5]；P=0.065）、LV 质量（-0.13 g/m2 [- 1.6 至 1.3]，P=0.86），或右心室射血分数（-0.23% [-1.2 至 0.8]，P=0.65）。然而，DM 患者的左心室和右心室容积均显着较小（左心室舒张末期容积/m2：-3.46 mL/m2 [-5.8 至 -1.2]，P=0.003，右心室舒张末期容积/m2：- 4.2 mL/m2 [-6.8 至 -1.7]，P=0.001，左心室每搏输出量/m2：-3.0 mL/m2 [-4.5 至 -1.5]，P<0.001；右心室每搏输出量/m2：-3.8 mL/ m2 [-6.5 至 -1.1]，P=0.005)，左心室质量/体积：0.026（0.01 至 0.04）g/mL，P=0.006。糖尿病患者的左心房和右心房排空分数均较低（右心房排空分数：-6.2% [-10.2 至 -2.1]，P=0.003；左心房排空分数：-3.5% [-6.9 至 -0.1]，P =0.043）。DM 患者左心室整体周向应变受损（系数 [95% CI]：0.38% [0.01 至 0.7]，P=0.045）。结论 在没有已知心血管疾病且左心室射血分数保留的低风险普通人群中，DM 与所有 4 个心室的早期变化相关。这些发现表明，糖尿病性心肌病不是左心室的局部病症，而是影响整个心脏。