Sachs R N, Valensi P, Lormeau B, Taupin J M, Nitenberg A, Metz D, Talvard O, Paries J, Dali M, Leutenegger M, Attali J R
Department of Cardiovascular Diseases, Clinique du Vert Galant, Tremblay en France, France.
Diabetes Metab. 1999 Jun;25(2):128-36.
Left ventricular hypertrophy (LVH) is a recognized independent risk factor for cardiovascular morbidity and mortality. The purpose of this study was to assess the determinants of left ventricular mass index (LVMI), according to the presence or absence of silent myocardial ischaemia (SMI), in diabetic patients with at least two additional risk factors but with no known coronary artery disease. Eighty diabetic patients (14 Type 1 and 66 Type 2) were studied, and LVMI was measured echocardiographically. Three non-invasive tests (the ECG stress test, thallium-201 myocardial scintigraphy with intravenous dipyridamole infusion, and ambulatory 48-h ECG monitoring) were performed on all patients. Forty-five percent of patients had LVH (LVMI > or = 110 g/m2 in men and > or = 106 g/m2 in women). Twenty-six patients (37%) had SMI assessed on at least one of the non-invasive tests, 7 of whom had significant coronary stenoses on angiography. LVMI was significantly higher in patients with coronary stenoses on angiography than in those with SMI but without coronary stenoses or in those without SMI (p < 0.05), and was correlated with systolic blood pressure. In patients free of SMI, LVMI correlated with creatininemia. In patients with SMI and normal coronary arteries on angiography, LVMI correlated with the waist/hip girth ratio, the log urinary albumin excretion rate and the red blood cell filtration index (a rigidity index). This study suggests that LVH is very frequent in diabetic patients and that the main factor contributing to the increase of LVMI differs according to the presence or absence of SMI and coronary stenoses: volume load in patients free of SMI, microcirculatory disorders in those with SMI but with normal coronary arteries, and blood pressure in those with coronary stenoses.
左心室肥厚（LVH）是公认的心血管发病和死亡的独立危险因素。本研究的目的是评估在至少有另外两个危险因素但无已知冠状动脉疾病的糖尿病患者中，根据有无无症状心肌缺血（SMI）来确定左心室质量指数（LVMI）的决定因素。研究了80例糖尿病患者（14例1型和66例2型），并通过超声心动图测量LVMI。对所有患者进行了三项非侵入性检查（心电图负荷试验、静脉注射双嘧达莫后的铊-201心肌闪烁显像以及48小时动态心电图监测）。45%的患者有LVH（男性LVMI≥110 g/m²，女性LVMI≥106 g/m²）。26例患者（37%）在至少一项非侵入性检查中被评估为有SMI，其中7例在血管造影时有明显冠状动脉狭窄。血管造影显示有冠状动脉狭窄的患者的LVMI显著高于有SMI但无冠状动脉狭窄的患者或无SMI的患者（p<0.05），并且与收缩压相关。在无SMI的患者中，LVMI与肌酐血症相关。在血管造影显示有SMI且冠状动脉正常的患者中，LVMI与腰臀围比、尿白蛋白排泄率对数以及红细胞滤过指数（一种刚性指数）相关。本研究表明，LVH在糖尿病患者中非常常见，并且导致LVMI增加的主要因素根据有无SMI和冠状动脉狭窄而有所不同：无SMI的患者为容量负荷，有SMI但冠状动脉正常的患者为微循环障碍，有冠状动脉狭窄的患者为血压。
