BACKGROUND The pathogenesis and cardiovascular impact of type 2 diabetes (T2D) may be different in South Asians compared with other ethnic groups. The phenotypic characterization of diabetic cardiomyopathy remains debated and little is known regarding differences in T2D-related cardiovascular remodeling across ethnicities. We aimed to characterize the differences in left ventricular (LV) diastolic and systolic function, LV structure, myocardial tissue characteristics and aortic stiffness between T2D patients and controls and to assess the differences in T2D-related cardiovascular remodeling between South Asians and Europeans. METHODS T2D patients and controls of South Asian and European descent underwent 3 Tesla cardiovascular magnetic resonance imaging (CMR) and cardiac proton-magnetic resonance spectroscopy (1H-MRS). Differences in cardiovascular parameters between T2D patients and controls were examined using ANCOVA and were reported as mean (95% CI). Ethnic group comparisons in the association of T2D with cardiovascular remodeling were made by adding the interaction term between ethnicity and diabetes status to the model. RESULTS A total of 131 individuals were included (54 South Asians [50.1 ± 8.7 years, 33% men, 33 patients vs. 21 controls) and 77 Europeans (58.8 ± 7.0 years, 56% men, 48 patients vs. 29 controls)]. The ratio of the transmitral early and late peak filling rate (E/A) was lower in T2D patients compared with controls, in South Asians [- 0.20 (- 0.36; - 0.03), P = 0.021] and Europeans [- 0.20 (- 0.36; - 0.04), P = 0.017], whereas global longitudinal strain and aortic pulse wave velocity were similar. South Asian T2D patients had a higher LV mass [+ 22 g (15; 30), P < 0.001] (P for interaction by ethnicity = 0.005) with a lower extracellular volume fraction [- 1.9% (- 3.4; - 0.4), P = 0.013] (P for interaction = 0.114), whilst European T2D patients had a higher myocardial triglyceride content [+ 0.59% (0.35; 0.84), P = 0.001] (P for interaction = 0.002) than their control group. CONCLUSIONS Diabetic cardiomyopathy was characterized by impaired LV diastolic function in South Asians and Europeans. Increased LV mass was solely observed among South Asian T2D patients, whereas differences in myocardial triglyceride content between T2D patients and controls were only present in the European cohort. The diabetic cardiomyopathy phenotype may differ between subsets of T2D patients, for example across ethnicities, and tailored strategies for T2D management may be required.

中文翻译：

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在欧洲人和南亚人中对糖尿病性心肌病进行表型分型。

背景技术与其他种族相比，南亚2型糖尿病（T2D）的发病机制和心血管影响可能有所不同。糖尿病性心肌病的表型特征尚有争议，关于跨种族与T2D相关的心血管重塑的差异知之甚少。我们旨在表征T2D患者和对照组之间左心室（LV）舒张和收缩功能，LV结构，心肌组织特征和主动脉僵硬的差异，并评估南亚人和欧洲人在T2D相关的心血管重塑方面的差异。方法对南亚和欧洲血统的T2D患者和对照组进行3特斯拉心血管磁共振成像（CMR）和心脏质子磁共振波谱（1H-MRS）。使用ANCOVA检查了T2D患者和对照组之间心血管参数的差异，并报告为平均值（95％CI）。通过将种族与糖尿病状况之间的相互作用项添加到模型中，可以比较T2D与心血管重塑之间的种族差异。结果共纳入131人（54位南亚人[50.1±8.7岁，男性33％，33例患者与21位对照者）和77位欧洲人（58.8±7.0岁，56％男性，48位患者与29位对照者）] 。与对照组相比，T2D患者的早期和晚期峰值填充率（E / A）的比率较低，在南亚人中为[-0.20（-0.36;-0.03），P = 0.021]，在欧洲人中为[-0.20（- 0.36;-0.04），P = 0.017]，而整体纵向应变和主动脉脉搏波速度相似。南亚T2D患者的LV质量较高[+ 22 g（15; 30），P <0.001]（种族间相互作用的P = 0.005），而细胞外体积分数较低[-1.9％（-3.4;-0.4）， P = 0.013]（相互作用的P = 0.114），而欧洲T2D患者的心肌甘油三酯含量比对照组高[+ 0.59％（0.35; 0.84），P = 0.001]（相互作用P = 0.002）。结论在南亚人和欧洲人中，糖尿病性心肌病的特征是左心室舒张功能受损。仅在南亚T2D患者中观察到LV质量增加，而T2D患者与对照组之间的心肌甘油三酯含量差异仅在欧洲队列中存在。糖尿病性心肌病的表型可能在T2D患者子集之间有所不同，例如，在不同种族之间，