Periodontitis links to exacerbation of myocardial dysfunction in subjects with type 2 diabetes

Abstract

Background and Objective Subjects with diabetes and periodontitis are at high risk of cardiovascular events, while the subclinical alterations of cardiac function in this cohort remain unclear. This cross‐sectional study investigated the association of periodontitis with left ventricle (LV) structural and functional abnormalities in subjects with type 2 diabetes mellitus (T2DM). Material and Methods A total of 115 subjects with T2DM were divided into Control group (n = 32) with no or mild periodontitis, and the rest with moderate to severe chronic periodontitis (CP) were further categorized into CP‐1 (n = 41) and CP‐2 (n = 42) based on disease severity. Echocardiography was performed to precisely assess (a) LV hypertrophy by LV mass index (LVMi); (b) LV diastolic function by tissue Doppler imaging index E/e’ ratio; and (c) LV systolic function by speckle tracking derived global longitudinal strain (GLS). Results Overall, a linear trend in LVMi, E/e’, and GLS existed among the Control, CP‐1, and CP‐2 groups, respectively (P < 0.05). After adjustments of multiple confounders, CP‐2 subjects showed significantly higher E/e’ (log scale, 2.22 ± 0.05 vs 2.07 ± 0.06, P < 0.01) and GLS (−17.42 ± 0.46% vs −18.95 ± 0.54%, P < 0.05) than the Controls. Multivariate analysis revealed that sites% with probing depth ≥4 mm and sites% with clinical attachment loss ≥5 mm were independent indicators for E/e’ (β = 0.005 and β = 0.002, P < 0.01) and GLS (β = 0.03 and β = 0.02, P < 0.05) , respectively. Moreover, the number of missing teeth was significantly associated with LVMi (β = 0.01, P < 0.01). Conclusion This study provides the first evidence that severe periodontitis is significantly associated with the exacerbation of LV diastolic and systolic dysfunction in subjects with T2DM.

A randomized controlled trial of the effects of non‐surgical periodontal therapy on cardiac function assessed by echocardiography in type 2 diabetic patients

“…As shown in our recent study on patients with T2DM (Wang et al., 2019), the E/e' ratio in the subjects with no or mild periodontitis and those with severe periodontitis was 8.4 ± 1.7 (standard deviation, SD ) and 10.5 ± 2.9 ( SD ), respectively. Assuming the clinically important reduction in E/e' ratio of 2.1 following periodontal treatment with the anticipated SD observed in the above‐mentioned study, a two‐sided significance level (α = 0.05) and a dropout rate of 20%, a sample size of 29 in each group would provide 80% detection power as calculated by G*Power (Version 3.01; Win) (Faul, Erdfelder, Lang, & Buchner, 2007).…”

“…On the other hand, LVMI was not altered significantly following the treatment. Our recent study has demonstrated that LVMI is independently correlated with periodontal destruction, rather than the existing periodontal conditions measured by BOP and PD (Wang et al., 2019). Given that the alteration in LV wall thickness is a long process, short‐term control of periodontal inflammation may not necessarily lead to a significant decrease in LV mass.…”

“…Periodontitis is associated with LV hypertrophy assessed by LV mass index (LVMI) in DM patients, and attachment loss could be an independent indicator for the progression of LV hypertrophy (Franek et al., 2010; Napora, Grabowska, & Gorska, 2016). Our recent study demonstrates for the first time that periodontitis exacerbates LV dysfunction measured by E/e' ratio and global longitudinal strain in T2DM patients (Wang et al., 2019). Such abnormalities in LV structure and function may to some extent help explain the established periodontitis‐CVD interlink in DM patients.…”

“…Hypertension was defined as either resting systolic or diastolic blood pressure (SBP/DBP) ≥140/90 mmHg from at least two separate visits, and hyperlipidaemia was detected following the current guideline (Reiner et al., 2011). Diabetic microvascular complications including retinopathy, nephropathy and peripheral neuropathy were recorded as described previously (Wang et al., 2019). Smokers were referred to those self‐reporting current/former tobacco use.…”

“…The details of echocardiographic analysis have been previously described (Wang et al., 2019). In brief, LVMI was obtained from the Devereux's formula following the guidelines of the American Society of Echocardiography (Lang et al., 2015).…”