The association between fragmented QRS and left ventricular diastolic dysfunction in type 2 diabetes patients with or without microalbuminuria.

BACKGROUND

Cardiovascular disease (CVD) is the leading cause of death in patients with type 2 diabetes mellitus (T2DM), and left ventricular diastolic dysfunction (LVDD) is considered one of the earliest markers of myocardial dysfunction. Fragmented QRS (fQRS) and microalbuminuria (MAU) are important biomarkers of cardiac electrophysiological changes and CVD, but their relationship with LVDD in T2DM remains unclear. This study aims to explore the impact of fQRS and MAU on LVDD in T2DM patients and to analyze whether the association between fQRS and LVDD differs across varying MAU statuses.

METHODS

A total of 374 patients with T2DM were ultimately enrolled in this study. Twelve-lead electrocardiography (ECG) and echocardiography were performed, and the patients' baseline characteristics, laboratory results, and echocardiographic parameters were collected. Univariate and multivariate logistic regression analyses were conducted to assess the association between fQRS, MAU, and LVDD in T2DM patients. A stratified analysis was performed to examine the relationship between fQRS and LVDD across different MAU statuses.

RESULTS

The mean age of the T2DM patients was 57.19±12.47 years, and 62.57% were male. fQRS, MAU, and age were independent risk factors for LVDD in patients with T2DM. The risk of developing LVDD was 3.72 times higher in patients with fQRS compared to those without fQRS [95% CI=2.125-6.513, P<0.0001]. The risk of LVDD was 4.05 times higher in patients with MAU compared to those without MAU [95% CI=2.252-7.282, P<0.0001]. For each additional year of age, the risk of LVDD increased by 5.2% [95% CI=1.022-1.084, P=0.001]. Stratified analysis based on MAU status revealed that in patients without MAU, the association between fQRS and LVDD was stronger [OR=7.084, 95% CI=3.255-15.419, P<0.0001]. However, in patients with MAU, the relationship between fQRS and LVDD was no longer significant [OR=1.499, 95% CI=0.603-3.722, P=0.383].

CONCLUSIONS

Our study found that both fQRS and MAU are independent risk factors for LVDD in patients with T2DM. The presence of fQRS increased the risk of LVDD by 3.72 times, while MAU increased the risk by 4.05 times. Stratified analysis further revealed that in patients without MAU, the association between fQRS and LVDD was significantly stronger (OR=7.084, P<0.0001), while in patients with MAU, this association was no longer significant (P=0.383). These findings suggest that combining the detection of fQRS and MAU may provide valuable information for cardiovascular risk assessment in T2DM patients, helping to develop personalized intervention strategies and ultimately improving patient prognosis.