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首页> 外文期刊>The American Journal of Cardiology >Relation of heart-rate recovery to new onset heart failure and atrial fibrillation in patients with diabetes mellitus and preserved ejection fraction
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Relation of heart-rate recovery to new onset heart failure and atrial fibrillation in patients with diabetes mellitus and preserved ejection fraction

机译：保留射血分数的糖尿病患者心率恢复与新发性心力衰竭和心房颤动的关系

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Diabetic autonomic neuropathy is a possible link between abnormal metabolism in type 2 diabetes mellitus (T2DM) and risk for atrial fibrillation (AF) and heart failure (HF). The aim of this study was to elucidate the association between attenuated heart rate recovery (HRR) and these manifestations of myocardial dysfunction in T2DM. Nine hundred fourteen consecutive patients with T2DM (mean age 56 ?? 11 years, 508 men) without diabetes mellitus complications, with negative results on stress echocardiography, were enrolled. Patients with known cardiac disease were excluded. Demographics, clinical assessment, co-morbidities, and insulin use were collected prospectively. The association of HRR with new-onset HF and AF was sought using a Cox proportional-hazards model. There were 47 events (22 HF and 25 AF) during a median follow-up period of 7.8 years. Events were associated with age, exercise capacity, HRR, and left atrial volume index but not with baseline glycosylated hemoglobin, left ventricular mass index, or standard markers of diastolic function. In sequential Cox models for the combined outcomes, the model based on clinical data (age and gender; overall chi-square = 5.5) was not significantly improved by left atrial volume index (chi-square = 8.6, p = 0.10) or maximum METs (chi-square = 8.7, p = 0.07) but was significantly improved by adding HRR (chi-square = 19.7, p = 0.004). In addition, HRR provided significant incremental prognostic value regarding the composite end point (net reclassification improvement 19.2%, p = 0.04; integrated discrimination improvement 1.58%, p = 0.004). In conclusion, the association of HRR with subsequent HF and AF, independent of and incremental to left atrial volume index and other markers of abnormal cardiac structure and function, indicates a role for autonomic neuropathy as the link between metabolic and cardiac risk in patients with T2DM. ? 2013 Elsevier Inc. All rights reserved.
机译：糖尿病性自主神经病变是2型糖尿病（T2DM）异常代谢与房颤（AF）和心力衰竭（HF）风险之间的可能联系。这项研究的目的是阐明心率恢复减弱（HRR）与T2DM中心肌功能障碍的这些表现之间的关系。研究入选了941例T2DM患者（平均年龄56 ?? 11岁，508名男性），无糖尿病并发症，对应力超声心动图检查结果阴性。排除患有已知心脏病的患者。前瞻性地收集了人口统计学，临床评估，合并症和胰岛素使用情况。使用Cox比例风险模型寻求HRR与新发性HF和AF的关联。在7.8年的中位随访期内发生了47次事件（22 HF和25 AF）。事件与年龄，运动能力，HRR和左心房容积指数有关，但与基线糖基化血红蛋白，左心室质量指数或舒张功能的标准指标无关。在用于合并结果的连续Cox模型中，左心室体积指数（卡方= 8.6，p = 0.10）或最大METs并没有显着改善基于临床数据（年龄和性别;总体卡方= 5.5）的模型。 （卡方= 8.7，p = 0.07），但通过添加HRR显着改善（卡方= 19.7，p = 0.004）。此外，HRR在复合终点方面提供了显着的预后价值（净重分类改善19.2％，p = 0.04;综合辨别力改善1.58％，p = 0.004）。总之，HRR与随后的HF和AF的相关性与左心室容积指数以及其他异常心脏结构和功能的指标无关，且与左心室容积指数的递增有关，表明自主神经病变作为T2DM患者代谢与心脏风险之间的联系而起作用。 ？ 2013 Elsevier Inc.保留所有权利。

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