PMID- 38302987 OWN - NLM STAT- MEDLINE DCOM- 20240205 LR - 20240313 IS - 1475-2840 (Electronic) IS - 1475-2840 (Linking) VI - 23 IP - 1 DP - 2024 Feb 1 TI - The impact of type 2 diabetes mellitus on the clinical profile, myocardial fibrosis, and prognosis in non-ischemic dilated cardiomyopathy: a prospective cohort study. PG - 48 LID - 10.1186/s12933-024-02134-0 [doi] LID - 48 AB - BACKGROUND: The impact of the coexistence of type 2 diabetes mellitus (T2DM) in patients with non-ischemic dilated cardiomyopathy (DCM) on clinical profiles, myocardial fibrosis, and outcomes remain incompletely understood. METHOD: A total of 1152 patients diagnosed with non-ischemic DCM were prospectively enrolled from June 2012 to October 2021 and categorized into T2DM and non-T2DM groups. Clinical characteristics, cardiac function, and myocardial fibrosis evaluated by CMR were compared between the two groups. The primary endpoint included both all-cause mortality and heart transplantation. Cause of mortality was classified into heart failure death, sudden cardiac death, and non-cardiac death. Cox regression analysis and Kaplan-Meier analysis were performed to identify the association between T2DM and clinical outcomes. Propensity score matching (PSM) cohort including 438 patients was analyzed to reduce the bias from confounding covariates. RESULTS: Among the 1152 included DCM patients, 155 (13%) patients had T2DM. Patients with T2DM were older (55 +/- 12 vs. 47 +/- 14 years, P < 0.001), had higher New York Heart Association (NYHA) functional class (P = 0.003), higher prevalence of hypertension (37% vs. 21%, P < 0.001), atrial fibrillation (31% vs. 16%, P < 0.001), lower left ventricular (LV) ejection fraction (EF) (23 +/- 9% vs. 27 +/- 12%, P < 0.001), higher late gadolinium enhancement (LGE) presence (55% vs. 45%, P = 0.02), and significantly elevated native T1 (1323 +/- 81ms vs. 1305 +/- 73ms, P = 0.01) and extracellular volume fraction (ECV) (32.7 +/- 6.3% vs. 31.3 +/- 5.9%, P = 0.01) values. After a median follow-up of 38 months (interquartile range: 20-57 months), 239 patients reached primary endpoint. Kaplan-Meier analysis showed that patients with T2DM had worse clinical outcomes compared with those without T2DM in the overall cohort (annual events rate: 10.2% vs. 5.7%, P < 0.001). T2DM was independently associated with an increased risk of primary endpoint in the overall (Hazard ratio [HR]: 1.61, 95% CI: 1.13-2.33, P = 0.01) and PSM (HR: 1.54, 95% CI: 1.05-2.24, P = 0.02) cohorts. Furthermore, T2DM was associated with a higher risk of heart failure death (P = 0.006) and non-cardiac death (P = 0.02), but not sudden cardiac death (P = 0.16). CONCLUSIONS: Patients with T2DM represented a more severe clinical profile and experienced more adverse outcomes compared to those without T2DM in a large DCM cohort. TRIAL REGISTRATION: Trial registration number: ChiCTR1800017058; URL: https://www. CLINICALTRIALS: gov . CI - (c) 2024. The Author(s). FAU - Li, Yangjie AU - Li Y AD - Department of Cardiology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, P. R. China. FAU - Xian, Hong AU - Xian H AD - Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China. FAU - Xu, Yuanwei AU - Xu Y AD - Department of Cardiology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, P. R. China. FAU - Li, Weihao AU - Li W AD - Department of Cardiology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, P. R. China. FAU - Guo, Jiajun AU - Guo J AD - Department of Cardiology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, P. R. China. FAU - Wan, Ke AU - Wan K AD - Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China. FAU - Wang, Jie AU - Wang J AD - Department of Cardiology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, P. R. China. FAU - Xu, Ziqian AU - Xu Z AD - Department of Cardiology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, P. R. China. FAU - Zhang, Qing AU - Zhang Q AD - Department of Cardiology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, P. R. China. FAU - Han, Yuchi AU - Han Y AD - Wexner Medical Center, College of Medicine, The Ohio State University, Columbus, OH, 43210, USA. FAU - Sun, Jiayu AU - Sun J AD - Department of Radiology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China. FAU - Chen, Yucheng AU - Chen Y AD - Department of Cardiology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, P. R. China. chenyucheng2003@126.com. LA - eng SI - ChiCTR/ChiCTR1800017058 GR - ZYGD22013, ZYJC18003/1.3.5 project for disciplines of excellence-Clinical Research Incubation Project, West China Hospital, Sichuan University/ PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20240201 PL - England TA - Cardiovasc Diabetol JT - Cardiovascular diabetology JID - 101147637 RN - 0 (Contrast Media) RN - AU0V1LM3JT (Gadolinium) SB - IM MH - Humans MH - *Cardiomyopathy, Dilated/diagnostic imaging/complications MH - *Diabetes Mellitus, Type 2/complications/diagnosis MH - Contrast Media MH - Prospective Studies MH - Magnetic Resonance Imaging, Cine/adverse effects MH - Gadolinium MH - Prognosis MH - Stroke Volume MH - Fibrosis MH - *Heart Failure/diagnosis MH - Predictive Value of Tests PMC - PMC10835902 OTO - NOTNLM OT - Dilated cardiomyopathy OT - Myocardial fibrosis OT - Prognosis OT - Type 2 diabetes mellitus COIS- The authors declare no competing interests. EDAT- 2024/02/02 06:43 MHDA- 2024/02/05 06:42 PMCR- 2024/02/01 CRDT- 2024/02/02 00:06 PHST- 2023/09/14 00:00 [received] PHST- 2024/01/15 00:00 [accepted] PHST- 2024/02/05 06:42 [medline] PHST- 2024/02/02 06:43 [pubmed] PHST- 2024/02/02 00:06 [entrez] PHST- 2024/02/01 00:00 [pmc-release] AID - 10.1186/s12933-024-02134-0 [pii] AID - 2134 [pii] AID - 10.1186/s12933-024-02134-0 [doi] PST - epublish SO - Cardiovasc Diabetol. 2024 Feb 1;23(1):48. doi: 10.1186/s12933-024-02134-0.