Echocardiographic phenotypes of Chinese patients with type 2 diabetes may indicate early diabetic myocardial disease

AIM: Type 2 diabetes may impair cardiac structure and function at very early stage, other factors, for example, obesity and hypertension, can induce aforementioned abnormalities individually. This study aimed to explore precise prevention and treatment of diabetic cardiomyopathy (DCM) by using cluster analysis of echocardiographic variables. METHODS AND RESULTS: A total of 66 536 inpatients with diabetes from 2013 to 2018 were investigated, and 7112 patients were available for analysis after nadir. The cluster analysis was performed on echocardiographic variables to assess the clinical profiles and risk factors of clusters. Two clusters were identified. Cluster 1 with 3576 patients (50.3%, including 62.5% female) had hypertension in 62.4%, while the lower rate of obesity (13.7%). Ultrasound findings showed that 79.9% of them had left ventricular diastolic dysfunction (LVDD), the most characteristic change in the early stages of DCM. Systolic blood pressure (SBP), uric acid and antithrombin III were independent risk factors for LVDD (P < 0.0001); 64.0% of the 3536 patients in the second group were male, with a high prevalence of obesity (30.1%) and a higher prevalence of hypertension (79.5%), In particular, decreased systolic function and a high rate of LV hypertrophy (46.8%) represented the progressive phase of DCM (P < 0.0001). SBP, diastolic blood pressure, BMI and creatinine were independent correlates of LV mass index (P < 0.05). CONCLUSION: The cluster analysis of echocardiographic variables may improve the identification of groups of patients with similar risks and different disease courses and will facilitate the achievement of targeted early prevention and treatment of DCM.