Annonu A K, Fattah A A, Mokhtar M S, Ghareeb S, Elhendy A
Department of Cardiology, Cairo University Hospital, Cairo, Egypt.
J Am Soc Echocardiogr. 2001 Sep;14(9):885-91. doi: 10.1067/mje.2001.112892.
The aim of this study was to evaluate the relations between left ventricular (LV) functional abnormalities, microangiopathy, and autonomic dysfunction in patients with non-insulin-dependent diabetes mellitus (NIDDM). We studied 66 normotensive patients with NIDDM of > or =4 years' duration (age, 51 +/- 4.5 years; 35 men) and no clinical evidence of cardiac disease. Twenty-one healthy subjects matched for age and sex served as a control group. Echocardiography and Doppler studies were performed to assess LV systolic and diastolic function. Microangiopathy was assessed by fundus examination. Autonomic function was assessed by standing blood pressure and heart rate response to Valsalva maneuver. Patients with NIDDM had a lower ejection fraction (58% +/- 11% versus 66% +/- 4%, P <.0001), E-F deceleration slope (382 +/- 75 versus 427 +/- 31 cm/s(2), P <.05), and E velocity (55 +/- 11 vs. 58 +/- 6 cm/s, P =.02) of the mitral diastolic flow, compared with control subjects, respectively. Patients with ejection fraction <50% had a higher prevalence of retinopathy (65% versus 29%, P <.005), abnormal blood pressure response to standing (53% versus 8%, P <.0005), and proteinuria (65% versus 27%, P =.006). An inverse correlation was found between the duration of diabetes and both the ejection fraction (r = -0.53, P <.05) and E/A ratio (r = -0.4, P <.005). E/A ratio <1 was associated with a higher prevalence of retinopathy (49% versus 20%, P =.01) and abnormal blood pressure response to standing (29% versus 4%, P <.005). Patients with NIDDM and no symptoms of cardiovascular disease have a reduced LV systolic and diastolic function as compared with healthy subjects. LV systolic and diastolic abnormalities are correlated with the duration of diabetes and with other diabetic microangiopathies such as diabetic retinopathy and neuropathy.
本研究旨在评估非胰岛素依赖型糖尿病（NIDDM）患者左心室（LV）功能异常、微血管病变与自主神经功能障碍之间的关系。我们研究了66例血压正常、病程≥4年的NIDDM患者（年龄51±4.5岁；男性35例），且无心脏病的临床证据。21名年龄和性别匹配的健康受试者作为对照组。进行超声心动图和多普勒研究以评估左心室收缩和舒张功能。通过眼底检查评估微血管病变。通过站立血压和对瓦尔萨尔瓦动作的心率反应评估自主神经功能。与对照组相比，NIDDM患者的射血分数较低（58%±11%对66%±4%，P<.0001），二尖瓣舒张期血流的E-F减速斜率较低（382±75对427±31cm/s²，P<.05），E速度较低（55±11对58±6cm/s，P=.02）。射血分数<50%的患者视网膜病变患病率较高（65%对29%，P<.005），站立时血压反应异常（53%对8%，P<.0005），蛋白尿患病率较高（65%对27%，P=.006）。发现糖尿病病程与射血分数（r=-0.53，P<.05）和E/A比值（r=-0.4，P<.005）均呈负相关。E/A比值<1与视网膜病变患病率较高（49%对20%，P=.01）和站立时血压反应异常（29%对4%，P<.005）相关。与健康受试者相比，无心血管疾病症状的NIDDM患者左心室收缩和舒张功能降低。左心室收缩和舒张异常与糖尿病病程以及其他糖尿病微血管病变如糖尿病视网膜病变和神经病变相关。
