1
|
Cardiovascular Risk Stratification in Diabetic Retinopathy via Atherosclerotic Pathway in COVID-19/non-COVID-19 Frameworks using Artificial Intelligence Paradigm: A Narrative Review. Diagnostics (Basel) 2022; 12:diagnostics12051234. [PMID: 35626389 PMCID: PMC9140106 DOI: 10.3390/diagnostics12051234] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 05/11/2022] [Accepted: 05/11/2022] [Indexed: 11/18/2022] Open
Abstract
Diabetes is one of the main causes of the rising cases of blindness in adults. This microvascular complication of diabetes is termed diabetic retinopathy (DR) and is associated with an expanding risk of cardiovascular events in diabetes patients. DR, in its various forms, is seen to be a powerful indicator of atherosclerosis. Further, the macrovascular complication of diabetes leads to coronary artery disease (CAD). Thus, the timely identification of cardiovascular disease (CVD) complications in DR patients is of utmost importance. Since CAD risk assessment is expensive for low-income countries, it is important to look for surrogate biomarkers for risk stratification of CVD in DR patients. Due to the common genetic makeup between the coronary and carotid arteries, low-cost, high-resolution imaging such as carotid B-mode ultrasound (US) can be used for arterial tissue characterization and risk stratification in DR patients. The advent of artificial intelligence (AI) techniques has facilitated the handling of large cohorts in a big data framework to identify atherosclerotic plaque features in arterial ultrasound. This enables timely CVD risk assessment and risk stratification of patients with DR. Thus, this review focuses on understanding the pathophysiology of DR, retinal and CAD imaging, the role of surrogate markers for CVD, and finally, the CVD risk stratification of DR patients. The review shows a step-by-step cyclic activity of how diabetes and atherosclerotic disease cause DR, leading to the worsening of CVD. We propose a solution to how AI can help in the identification of CVD risk. Lastly, we analyze the role of DR/CVD in the COVID-19 framework.
Collapse
|
2
|
Eid M, Mounir A, El Etriby S, Al Taher A, Ezzat MAW. Diabetic Retinopathy as a Predictor of Angiographic Coronary Atherosclerosis Severity in Patients with Type 2 Diabetes Mellitus. Diabetes Metab Syndr Obes 2022; 15:1485-1494. [PMID: 35591908 PMCID: PMC9113458 DOI: 10.2147/dmso.s363406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 04/30/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Diabetic retinopathy (DR) is one of the most prevalent consequences of diabetes mellitus (DM). Much emphasis has been focused on the link between DR and cardiovascular disorders in patients with type 2 diabetes (T2DM). However, there is little information about the relation between the degree of DR and coronary atherosclerosis severity in Egyptian patients. AIM To assess the correlation between the degree of DR and the coronary atherosclerosis severity in T2DM. PATIENTS AND METHODS This work included 140 diabetic patients with T2DM who underwent diagnostic coronary angiography because of suspected coronary artery disease (CAD). All participants were evaluated by history, fundus assessment, laboratory tests (lipid profile and glycated hemoglobin [HbA1c]), and selective coronary angiography. The severity of coronary artery lesion was detected by Gensini score and vessel score. RESULTS Patients with DR had a significantly higher Gensini score (67.86± 44.56 versus 5.93± 9.02, P < 0.001) and a vessel score (2.29± 0.86 versus 0.50± 0.66, P < 0.001). There was a significant relation between the degree of DR, Gensini score (P < 0.001), and vessel score (P < 0.001), as both scores increased according to the severity of DR. The presence and degree of retinopathy were the only independent factors linked to the severity score in multivariate linear regression analyses (P < 0.001). CONCLUSION The presence and degree of DR are independent predictors of severe coronary atherosclerosis. Therefore, when evaluating whether a patient with T2DM is at high risk for CAD, the DR degree should be taken into consideration.
Collapse
Affiliation(s)
- Mohamed Eid
- Department of Internal Medicine, Sohag University Hospital, Sohag University, Sohag, Egypt
| | - Amr Mounir
- Department of Ophthalmology, Sohag Faculty of Medicine, Sohag University, Sohag, Egypt
- Correspondence: Amr Mounir, Email
| | - Shehab El Etriby
- Department of Cardiology, Ain Shams Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Ali Al Taher
- Department of Internal Medicine, Sohag University Hospital, Sohag University, Sohag, Egypt
| | - Mohamed A W Ezzat
- Department of Internal Medicine, Sohag University Hospital, Sohag University, Sohag, Egypt
| |
Collapse
|
3
|
Kurtul BE, Kurtul A, Yalçın F. Predictive value of the SYNTAX score for diabetic retinopathy in stable coronary artery disease patients with a concomitant type 2 diabetes mellitus. Diabetes Res Clin Pract 2021; 177:108875. [PMID: 34058301 DOI: 10.1016/j.diabres.2021.108875] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 03/13/2021] [Accepted: 05/26/2021] [Indexed: 11/15/2022]
Abstract
AIMS Diabetic retinopathy (DR) is a serious complication of type 2 diabetes mellitus (T2DM) and is the most common cause of impaired vision for adults. DR is related to a number of risk factors. The aim of this study was to investigate the relationship between burden of coronary artery disease assessed by Syntax Score (SS) and DR in T2DM. METHODS A total of 96 T2DM patients undergoing coronary angiography were prospectively included in the study. Presence and severity of DR were assessed by ocular fundus examination. DR was graded as no apparent retinopathy (NDR), non-proliferative (NPDR), and proliferative DR (PDR). The SS for each patient was calculated. RESULTS The mean age was 58.0 ± 8.2 years. SS gradually increased from NDR group to PDR group. The median (IQR) value of SS was 10 (5-16) in patients with NDR, 22.8 (17-35.8) in those with NPDR, and 35.5 (28-37) in those with PDR (p < 0.001). On multivariate analysis SS [odds ratio (OR) 1.145, p = 0.001] and duration of diabetes (OR 1.753, p = 0.031) were independent factors for DR. CONCLUSIONS The SS is independently associated with the occurrence of DR in T2DM. Ophthalmologists and cardiologists must cooperate when evaluating patients with DM because of possible complications.
Collapse
Affiliation(s)
- Bengi Ece Kurtul
- Hatay Mustafa Kemal University, Tayfur Ata Sökmen Faculty of Medicine, Department of Ophthalmology, Hatay, Turkey.
| | - Alparslan Kurtul
- Hatay Mustafa Kemal University, Tayfur Ata Sökmen Faculty of Medicine, Department of Cardiology, Hatay, Turkey
| | - Fatih Yalçın
- Hatay Mustafa Kemal University, Tayfur Ata Sökmen Faculty of Medicine, Department of Cardiology, Hatay, Turkey
| |
Collapse
|
4
|
Gao L, Zhao W, Yang JK, Qin MZ. Proliferative diabetic retinopathy in patients with type 2 diabetes correlates with the presence of atherosclerosis cardiovascular disease. Diabetol Metab Syndr 2021; 13:48. [PMID: 33902673 PMCID: PMC8077820 DOI: 10.1186/s13098-021-00666-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 04/13/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Atherosclerosis cardiovascular disease (ASCVD) is the main cause of morbidity and mortality in type 2 diabetes mellitus (T2DM). As most diabetic patients with ASCVD are asymptomatic, it is most neglected in clinical practice. For this reason, identifying high-risk ASCVD population with intensified treatment is very important. In recent years, the relationship between diabetic retinopathy (DR) and ASCVD has caused much academic concern, but the results are inconsistent. Moreover, whether all grades of DR increase the risk of ASCVD remains controversial. Most importantly, very few data can be found in China. OBJECTIVE Our aim is to discuss whether all grades of DR increase the risk of ASCVD after adjustment for the traditional cardiovascular risk factors and to assess the independent contribution of DR to cardiovascular events in patients with T2DM, hoping to provide more evidence for early identification of ASCVD. RESEARCH DESIGN AND METHODS A total of 425 T2DM patients with complete physical and biochemical data were included in the study. The grade of DR was assessed with two 45 color digital retinal images. Based on the presence of history of ASCVD, 425 T2DM patients were divided into 2 groups: ASCVD group and non-ASCVD group. RESULTS ASCVD patients were older and had a significantly higher fasting plasma glucose (FPG) and glycated haemoglobin (HbA1c) and proportion of history of ASCVD. At the same time, they were more likely to be females, and had lower level of alcohol and calculated glomerular filtration rate (eGFR) than non-ASCVD patients. Their trend to develop DR with ASCVD was significantly higher than patients with non-ASCVD (χ2 = 5.805, P = 0.016). DR was an independent statistical indicator of the presence of ASCVD [odds ratio (OR) (95% CI): 2.321 (1.152-4.678), P = 0.018]. Furthermore, when DR was divided into non-proliferative retinopathy (NPDR) and proliferative retinopathy (PDR) according to its severity, only PDR was significantly associated with incident ASCVD [OR (95% CI): 8.333 (1.813-38.304), P = 0.006]. After adjusting for traditional ASCVD risk factors, such an association still existed [OR (95% CI): 7.466 (1.355-41.137), P = 0.021]. CONCLUSION DR associates strongly with ASCVD in the Chinese population with T2DM. With the increasing severity of DR, the risk of ASCVD also increases. After adjustment for traditional risk factors, PDR is still an independent risk marker for ASCVD.
Collapse
Affiliation(s)
- Lu Gao
- Department of Geriatrics, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - Wei Zhao
- Department of Geriatrics, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - Jin-Kui Yang
- Department of Endocrinology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Ming-Zhao Qin
- Department of Geriatrics, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China.
| |
Collapse
|
5
|
Gverović Antunica A, Bućan K, Kaštelan S, Kaštelan H, Ivanković M, Šikić M. Prevalence of diabetic retinopathy in the Dubrovnik-Neretva County. Cent Eur J Public Health 2019; 27:160-164. [PMID: 31241293 DOI: 10.21101/cejph.a5213] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 04/29/2019] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Diabetic retinopathy is one of the leading causes of blindness. We estimated the prevalence of diabetic retinopathy among a diabetic population in the Dubrovnik-Neretva County in the Republic of Croatia and searched for potential risk factors. METHODS A prospective study was performed with 600 diabetic patients from different parts of the Dubrovnik-Neretva County who attended regular medical and ophthalmological check-ups at the General Hospital Dubrovnik from September 2014 to September 2015. Patients underwent a complete medical assessment by two ophthalmologists. Retinal examination included evaluation of the presence of diabetic retinopathy. Any retinopathy present was graded as mild non-proliferative retinopathy, moderate-severe non proliferative retinopathy or proliferative retinopathy. RESULTS Retinopathy was present in 44.5% of the study sample. 20.7% had the mild form of diabetic retinopathy, 18.8% had the moderate-severe form, and 5.0% had proliferative diabetic retinopathy. The mean duration of diabetes was 12.94 years ± 6.85; 12.89 years ± 9.18 in men, 12.94 ± 6.54 in women. The mean BMI was 27.14 ± 2.98; for diabetics without diabetic retinopathy 26.19 ± 2.75; for those with the mild form 28.06 ± 3.01; for those with the moderate-severe form 28.49 ± 2.54; for those with proliferative diabetic retinopathy 28.79 ± 3.16. 168 (28%) patients were treated by laser and 22 (3.7%) by vitrectomy. CONCLUSION The prevalence of diabetic retinopathy in the Dubrovnik-Neretva County is 44.5%. Regular screening to detect diabetic retinopathy is highly recommended as timely intervention can prevent most diabetic causes of blindness.
Collapse
Affiliation(s)
| | - Kajo Bućan
- University Department of Ophthalmology, Clinical Hospital Split, Split, Croatia
| | - Snježana Kaštelan
- Department of Ophthalmology, Clinical Hospital Dubrava, Zagreb, Croatia
| | - Helena Kaštelan
- Department of Ophthalmology, General Hospital Dubrovnik, Dubrovnik, Croatia
| | - Mira Ivanković
- Department of Neurology, General Hospital Dubrovnik, Dubrovnik, Croatia
| | - Maja Šikić
- Medical Centre Dubrovnik, Dubrovnik, Croatia
| |
Collapse
|
6
|
Zhou JB, Zhu XR, Zhao W, Yin L, Li HB, Qi L, Yang JK. Prediction of Proliferative Diabetic Retinopathy to Asymptomatic Obstructive Coronary Artery Disease in Chinese Type 2 Diabetes Individuals: An Exploratory Study. Metab Syndr Relat Disord 2019; 17:367-373. [PMID: 31145036 PMCID: PMC6708263 DOI: 10.1089/met.2018.0140] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Background: Patients with type 2 diabetes are prone to the asymptomatic obstructive coronary artery disease (AO-CAD). The association of proliferative diabetic retinopathy (PDR) with AO-CAD is unknown. The aim of the study is to explore the specific relationship of PDR with AO-CAD. Methods: We performed coronary angiography and retinal photographs in 1332 participants with unknown CAD status in a retrospective discovery set and 252 patients with non-CAD enrolled in a prospective validation cohort. Main outcome measures are prediction of PDR to AO-CAD. Results: In the case–control retrospective discovery set, investigation included 211 nondiabetic retinopathy (NDR) and 140 PDR. Individuals with PDR had a 2.16 times higher risk of AO-CAD compared with individuals without diabetic retinopathy (P < 0.01). Relative risk between individuals with PDR and the risk of AO-CAD varied by different adjusted covariates, 2.53 (1.48–4.32) by age and gender; 2.16 (1.10–4.31) by additionally other covariates. In the prospective validation set, after adjustment for covariates, the cumulative risk of AO-CAD was significantly higher in the PDR group compared with NDR group, followed up for a median of 4.3 years (hazard ratio = 3.07, 95% confidence interval 1.81–5.21, P < 0.001). Conclusions: PDR showed superior identification performance over traditional risk factors in screening for AO-CAD. PDR may predict persons at high risk of AO-CAD.
Collapse
Affiliation(s)
- Jian-Bo Zhou
- Department of Endocrinology, Beijing Tongren Hospital, Capital Medical University, Beijing, China.,Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana
| | - Xiao-Rong Zhu
- Department of Endocrinology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Wei Zhao
- Department of Geriatrics, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Lu Yin
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hong-Bing Li
- Department of Endocrinology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Lu Qi
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana
| | - Jin-Kui Yang
- Department of Endocrinology, Beijing Tongren Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Diabetes Research and Care, Beijing, China
| |
Collapse
|
7
|
Xiao-Rong Z, Hui-Rong Z, Mei L, Zhen Z, Wei L, Jing L, Guang-Ran Y, Jian-Bo Z, Jin-Kui Y. Risk of silent myocardial ischemia detected by single photon emission computed tomography (SPECT) among asymptomatic Chinese patients with type 2 diabetes. Medicine (Baltimore) 2019; 98:e15618. [PMID: 31096471 PMCID: PMC6531126 DOI: 10.1097/md.0000000000015618] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
To explore the prevalence and risk factors of silent myocardial ischemia (SMI) detected by using single photon emission computed tomography (SPECT) in Chinese asymptomatic patients with type 2 diabetes (T2D).In this hospital-based retrospective study, 821 T2D patients who were screened for SMI detected by stress myocardial perfusion imaging using SPECT between June 2014 and July 2016 were investigated. Clinical indicators were compared between the patients with SMI and controls without SMI. Risk factors for SMI were evaluated by univariate and multivariate analysis.In this study, there were 131 patients with SMI in asymptomatic diabetes and the prevalence of SMI was 21.3% of 614 individuals. Logistic regression analysis indicated that diabetic retinopathy (OR = 1.474, 95%CI: 1.113-1.951, P = .007), male gender (OR = 1.805, 95%CI: 1.183-2.747, P = .006), and low-density lipoprotein (LDL) cholesterol (OR = 1.298, 95%CI: 1.042-1.615, P = .02) were risk factors associated with SMI. Besides, the prevalence of SMI increased in associated with the progression of retinopathy (P = .041). The percentage of SMI diagnosed in patients with no diabetic retinopathy (NDR), non-proliferative diabetic retinopathy (NPDR), and proliferative diabetic retinopathy (PDR) were 18.5% (75/405), 25.2% (37/147), and 30.6% (19/62), respectively. The percentage of SMI in male (24.5%, 85/347) was higher than that in female (17.2%, 46/267), P = .029.Physicians should be aware of these conditions when examining male patients with type 2 diabetes, especially with DR and/or high level of low-density lipoprotein cholesterol (LDL cholesterol), even if otherwise asymptomatic. A routine screening for SMI may thus be considered advisable in these patients.
Collapse
Affiliation(s)
- Zhu Xiao-Rong
- Department of Endocrinology, Beijing Tongren Hospital, Capital Medical University
| | - Zhang Hui-Rong
- Department of Endocrinology, Beijing Tongren Hospital, Capital Medical University
| | - Li Mei
- Department of Nuclear Medicine Department, Beijing Tongren Hospital
| | - Zhou Zhen
- Department of Mathematics, School of Biomedical Engineering, Capital Medical University, Beijing
| | - Liu Wei
- Department of Endocrinology, Beijing Tongren Hospital, Capital Medical University
| | - Lu Jing
- Department of Endocrinology, Beijing Tongren Hospital, Capital Medical University
- Beijing Key Laboratory of Diabetes Research and Care
| | - Yang Guang-Ran
- Department of Endocrinology, Beijing Tongren Hospital, Capital Medical University
| | - Zhou Jian-Bo
- Department of Endocrinology, Beijing Tongren Hospital, Capital Medical University
| | - Yang Jin-Kui
- Department of Endocrinology, Beijing Tongren Hospital, Capital Medical University
- Beijing Key Laboratory of Diabetes Research and Care
- Beijing Diabetes Institute, China
| |
Collapse
|
8
|
Niknami M, Mirbalouchzehi A, Zareban I, Kalkalinia E, Rikhtgarha G, Hosseinzadeh H. Association of health literacy with type 2 diabetes mellitus self-management and clinical outcomes within the primary care setting of Iran. Aust J Prim Health 2019; 24:162-170. [PMID: 29622058 DOI: 10.1071/py17064] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 12/28/2017] [Indexed: 11/23/2022]
Abstract
This study explores the potential association of health literacy with type 2 diabetes mellitus (T2DM) self-management and clinical outcomes in the primary care setting of Iran. A total of 347 T2DM patients, mostly female (52.4%), 50 years old or younger (63.1%), unemployed (53.6%) and rural residents (55.6%) participated in this study. Most of the respondents had type 2 diabetes mellitus (T2DM) for 2-5 years (63.1%) and did not receive any T2DM education (52.2%). Approximately 19.0% were hospitalised due to uncontrolled T2DM. Participants mainly found managing T2DM self-management behaviours difficult. Approximately half of the participants had poor fasting blood sugar (FBS) (47.0%) and haemoglobin A1c (HbA1c) (59.4%) control and were overweight or obese (77.6%). The level of health literacy was poor and most of the participants had difficulties reading hospital materials (66.0%), understanding medical materials (62.5%) and engaging in medical conversations (63.7%). Health literacy could predict 22.5% variance in difficulty of T2DM self-management and 3.8-23.3% variance in T2DM clinical outcomes after controlling for sociodemographic factors. Participants with higher health literacy were more likely to find managing T2DM less challenging and their clinical outcomes were within the normal range. This implies that interventions targeting patient's health literacy can be a promising tool for addressing the burden of T2DM.
Collapse
Affiliation(s)
- Marzieh Niknami
- School of Public Health and Community Medicine, Room 215, Level 2, Samuels Building, School of Public Health and Community Medicine, Faculty of Medicine, University of New South Wales, NSW 2052, Australia
| | - Ali Mirbalouchzehi
- Iranshahr University of Medical Sciences, Noor Street, Iranshahr, Sistan and Baluchestan Province, Iran
| | - Iraj Zareban
- Zahedan University of Medical Sciences, School of Public Health, Dr Hesabi Roundabout, Paradise Campus, Sistan and Baluchestan Province, Zahedan, Iran
| | - Elahibakhsh Kalkalinia
- Iranshahr University of Medical Sciences, Noor Street, Iranshahr, Sistan and Baluchestan Province, Iran
| | - Gasem Rikhtgarha
- Iranshahr University of Medical Sciences, Noor Street, Iranshahr, Sistan and Baluchestan Province, Iran
| | - Hassan Hosseinzadeh
- School of Health & Society, Building 15, Room G26, University of Wollongong NSW 2522, Australia
| |
Collapse
|
9
|
Chung YR, Park SJ, Moon KY, Choi SA, Lim HS, Park SW, Kim JH, Lee K. Diabetic retinopathy is associated with diastolic dysfunction in type 2 diabetic patients with non-ischemic dilated cardiomyopathy. Cardiovasc Diabetol 2017; 16:82. [PMID: 28683825 PMCID: PMC5500965 DOI: 10.1186/s12933-017-0566-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 06/20/2017] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND To investigate the association between diabetic retinopathy (DR) and myocardial dysfunction in patients with type 2 diabetes and dilated cardiomyopathy (dCMP). METHODS Data were collected retrospectively from 89 patients with dCMP (46 with type 2 diabetes and 43 without diabetes) and no evidence of coronary artery disease. Echocardiographic parameters and laboratory data, including lipid profiles and fundus findings, were obtained from medical records. A left ventricular ejection fraction (LVEF) less than 40% was considered impaired systolic function, while an E/E' ratio greater than 15 was considered elevated left ventricular (LV) filling pressure. RESULTS Baseline characteristics show that LVEF was not significantly different between patients with and without diabetes or between diabetic patients with and without DR. Among the diastolic function parameters, patients with DR exhibited higher E/E' ratios (left ventricular filling pressures) than patients without DR (23.75 ± 13.37 vs 11.71 ± 3.50, P = 0.022). Logistic regression analysis revealed that statin use lowered the risk of impaired systolic dysfunction in all patients (odds ratio (OR) 0.33, 95% confidence interval (CI) 0.12-0.92, P = 0.034) and in patients with diabetes (OR 0.273, 95% CI 0.08-0.99, P = 0.049), while the presence of DR was associated with a higher risk of elevated LV filling filling pressure in patients with diabetes (OR 18.00, 95% CI 1.50-216.62, P = 0.023). CONCLUSIONS In conclusion, DR was associated with elevated LV filling pressure in patients with dCMP. DR may not only represent microvascular long-term complications in patients with diabetes but may also be associated with more advanced form of diastolic dysfunction among diabetic patients with cardiomyopathy.
Collapse
Affiliation(s)
- Yoo-Ri Chung
- Department of Ophthalmology, Ajou University School of Medicine, 164 World Cup-ro, Yeongtong-gu, Suwon, 16499, South Korea
| | - Se-Jun Park
- Department of Cardiology, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, South Korea
| | - Ka Young Moon
- Department of Ophthalmology, Ajou University School of Medicine, 164 World Cup-ro, Yeongtong-gu, Suwon, 16499, South Korea
| | | | - Hong-Seok Lim
- Department of Cardiology, Ajou University School of Medicine, Suwon, South Korea
| | - Sung Wook Park
- Fight against Angiogenesis-Related Blindness (FARB) Laboratory, Clinical Research Institute, Seoul National University Hospital, Seoul, South Korea.,Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, South Korea
| | - Jeong Hun Kim
- Fight against Angiogenesis-Related Blindness (FARB) Laboratory, Clinical Research Institute, Seoul National University Hospital, Seoul, South Korea. .,Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, South Korea. .,Department of Ophthalmology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea.
| | - Kihwang Lee
- Department of Ophthalmology, Ajou University School of Medicine, 164 World Cup-ro, Yeongtong-gu, Suwon, 16499, South Korea.
| |
Collapse
|