关键词: 糖尿病, 2 型；左心室舒张功能障碍；中国内脏脂肪指数；内脏脂肪型肥胖；Logistic 模型

Abstract: Background　The incidence of type 2 diabetes mellitus (T2DM)has risen steadily in recent years. Cardiovascular disease is a common complication of T2DM, with left ventricular diastolic dysfunction (LVDD) often occurring at an early stage. Central (visceral) obesity is closely linked to cardiovascular risk; however, the performance of visceralfat-focused indices in identifying LVDD among patients with T2DM remains understudied. Objective　To evaluate the association between the Chinese Visceral Adiposity Index (CVAI) and LVDD in patients with T2DM and to assess CVAI's diagnostic utility. Methods　This retrospective study enrolled 1, 028 T2DM patients who attended the Second Affiliated Hospital of Kunming Medical University (Metabolic Management Center [MMC]) from January 2019 to August 2024 (647 males, 381 females) . Patients were classified as a T2DM group (n=257) or an LVDD group (n=771) based on the presence of LVDD. We assessed correlations between CVAI and other visceraltype obesity measures and echocardiographic structural and functional parameters. Multivariable logistic regression evaluated the independent association of CVAI with LVDD. Diagnostic performance was assessed by receiver operating characteristic (ROC) curves. Subgroup analyses were conducted by sex, age, and body mass index (BMI) . Results　Compared with the T2DM group, the LVDD group had higher BMI, neck circumference, waist circumference (WC) , hip circumference, visceral fat area (VFA) , and CVAI (P<0.05 for all) . When stratified by CVAI quartiles, LVDD prevalence increased across quartiles: Q1 64.2%, Q2 71.2%, Q3 79.4%, Q4 85.2% (χ2 trend=34.715, P<0.05) . Correlation analyses demonstrated that WC, BMI, VFA, and CVAI were positively correlated with left atrial diameter (LAD) , interventricular septal thickness (IVST) , left ventricular posterior wall thickness (LVPWT) , and left ventricular enddiastolic diameter (LVDd) , and negatively correlated with left ventricular ejection fraction (LVEF) (P<0.05) . After adjustment for confounders, patients in the CVAI Q4 group had a 2.361fold increased risk of LVDD compared with Q1 (95%CI=1.349-4.133, P=0.003) . ROC analysis yielded an area under the curve (AUC) of 0.621 for CVAI in diagnosing LVDD, outperforming VFA (0.557) , BMI (0.589) , and WC (0.599) . A combined predictive model achieved an AUC of 0.727 (95%CI=0.692-0.763, P<0.001) , with sensitivity 0.726 and specificity 0.638. Subgroup analyses indicated that CVAI Q4 was a significant risk factor for LVDD in both male and female subgroups (OR=1.948 and 8.617, respectively; P<0.05). In participants aged<60 years, CVAI Q3 and Q4 were associated with increased LVDD risk (OR=2.387 and 4.371, respectively; P<0.05) . In the normalBMI subgroup, CVAI Q3 was associated with higher LVDD risk (OR=3.997, P<0.05) . Conclusion　CVAI is an independent risk factor for LVDD among patients with T2DM and demonstrates superior discriminative ability compared with conventional obesity indices. Its predictive value is particularly notable in women and in individuals under 60 years of age.

Key words: Diabetes mellitus, type 2, Left ventricular diastolic dysfunction, Chinese Visceral Adiposity Index, Visceral fat obesity, Logistic models