Diamant Michaela, Lamb Hildo J, Groeneveld Ymte, Endert Edwin L, Smit Jan W A, Bax Jeroen J, Romijn Johannes A, de Roos Albert, Radder Jasper K
Department of Endocrinology, Leiden University Medical Center, Leiden, The Netherlands.
J Am Coll Cardiol. 2003 Jul 16;42(2):328-35. doi: 10.1016/s0735-1097(03)00625-9.
This study evaluated myocardial function in relation to high-energy phosphate (HEP) metabolism in asymptomatic patients with uncomplicated type 2 diabetes mellitus using magnetic resonance (MR) techniques.
Myocardial dysfunction may occur in patients with type 2 diabetes mellitus in the absence of coronary artery disease or left ventricular (LV) hypertrophy. The mechanisms underlying this diabetic cardiomyopathy are largely unknown, but may involve altered myocardial energy metabolism.
We assessed myocardial systolic and diastolic function and HEP metabolism in 12 asymptomatic normotensive male patients with recently diagnosed, well-controlled type 2 diabetes and 12 controls, using MR imaging and phosphorus-31-nuclear MR spectroscopy (31P-MRS) on a 1.5 T clinical scanner; 31P-MR spectra were quantified, and myocardial HEP metabolism was expressed as phosphocreatine to adenosine-triphosphate (PCr/ATP) ratio.
No differences were found in LV mass and systolic function between patients and controls. However, early (E) acceleration peak, deceleration peak, peak filling rate, and transmitral early-to-late diastolic peak flow (E/A) ratio, all indexes of diastolic function, were significantly decreased in patients compared with controls (p < 0.02). In addition, myocardial PCr/ATP in patients was significantly lower than in controls (1.47 vs. 1.88, p < 0.01). Inverse associations were found between myocardial PCr/ATP and E acceleration peak, E deceleration peak, and E peak filling rate (all, p < 0.05).
These results indicate that altered myocardial energy metabolism may contribute to LV diastolic functional changes in patients with recently diagnosed, well-controlled and uncomplicated type 2 diabetes.
本研究采用磁共振（MR）技术评估无症状的非复杂性2型糖尿病患者的心肌功能与高能磷酸（HEP）代谢之间的关系。
2型糖尿病患者在无冠状动脉疾病或左心室（LV）肥厚的情况下可能发生心肌功能障碍。这种糖尿病性心肌病的潜在机制在很大程度上尚不清楚，但可能涉及心肌能量代谢改变。
我们使用1.5T临床扫描仪上的MR成像和磷-31-核磁共振波谱（31P-MRS），对12例近期诊断为病情控制良好的无症状血压正常男性2型糖尿病患者和12例对照者进行心肌收缩和舒张功能以及HEP代谢评估；对31P-MR波谱进行定量分析，心肌HEP代谢以磷酸肌酸与三磷酸腺苷（PCr/ATP）比值表示。
患者与对照者之间的左心室质量和收缩功能无差异。然而，与对照者相比，患者的舒张功能指标，即早期（E）加速峰、减速峰、峰值充盈率和二尖瓣舒张早期至晚期峰值血流（E/A）比值均显著降低（p<0.02）。此外，患者的心肌PCr/ATP显著低于对照者（1.47对1.88，p<0.01）。心肌PCr/ATP与E加速峰、E减速峰和E峰值充盈率之间呈负相关（均p<0.05）。
这些结果表明，心肌能量代谢改变可能导致近期诊断为病情控制良好的非复杂性2型糖尿病患者的左心室舒张功能变化。
