Erbas T, Erbas B, Gedik O, Biberoglu S, Bekdik C F
Hacettepe University, Faculty of Medicine, Department of Nuclear Medicine, Ankara, Turkey.
Cardiology. 1992;81(1):14-24. doi: 10.1159/000175771.
Left ventricular function of 20 diabetic patients was investigated at rest and during hand-grip test using radionuclide ventriculography. The aim of the study was to discuss the correlation of cardiac function with autonomic cardiac neuropathy (ACN) in diabetic subjects. ACN was tested using heart rate response to valsalva maneuver, standing up, deep breathing; blood pressure response to standing up, sustained hand-grip, and additionally corrected QT (QTc) measurements. Plasma glucose regulation was screened with fructosamine levels. Ejection fraction (EF), peak ejection (PER) and filling rates (PFR), times to peak ejection (TPE) and filling (TPF), time to endsystole (TES), TES/T, TPE/T, TPF/T, 1/3 PER, 1/3 PFR, 1/3 EF, 1/3 FF (filling fraction) we calculated. Thirteen patients had ACN. Six patients (30%) had a low EF at rest. As a response to hand-grip, 14 patients (70%) showed a decrease in EF (9 ACN). PFR was low in 10 patients (50%) at rest and in 12 (60%) during hand-grip. The mean rest PER value of ACN+ patients (4.4 +/- 1.3) was significantly higher than that of controls (2.9 +/- 0.5) and patients without ACN (3.4 +/- 0.4; p < 0.05) as well as the mean 1/3 PER value (1.7 +/- 0.5 vs. 1.3 +/- 0.5; p < 0.05). Fourteen patients (70%) had a fall in PER 10 ACN) as a response to hand-grip. The mean TES/T value of patients with ACN (0.44 +/- 0.05) was significantly higher than of those without ACN (0.38 +/- 0.05; p < 0.05). In conclusion, diastolic dysfunction was detected frequently at rest. Systolic parameters were markedly impaired as a response to hand-grip in patients with ACN. Sympathetic overactivity was noted in ACN+ group at rest. Our results indicated that the patients with diabetes and ACN have subclinical left ventricular diastolic dysfunction and symphatic overactivity.
采用放射性核素心室造影术对20例糖尿病患者静息状态及手握力试验期间的左心室功能进行了研究。本研究的目的是探讨糖尿病患者心功能与心脏自主神经病变（ACN）之间的相关性。通过valsalva动作、站立、深呼吸时的心率反应；站立、持续手握力时的血压反应以及校正QT（QTc）测量来检测ACN。用果糖胺水平筛查血浆葡萄糖调节情况。计算射血分数（EF）、射血峰值（PER）和充盈率（PFR）、达到射血峰值的时间（TPE）和充盈时间（TPF）、收缩末期时间（TES）、TES/T、TPE/T、TPF/T、1/3 PER、1/3 PFR、1/3 EF、1/3 FF（充盈分数）。13例患者存在ACN。6例患者（30%）静息时EF值较低。作为对手握力的反应，14例患者（70%）EF值下降（9例为ACN患者）。10例患者（50%）静息时PFR较低，12例患者（60%）手握力试验时PFR较低。ACN阳性患者的平均静息PER值（4.4±1.3）显著高于对照组（2.9±0.5）和无ACN的患者（3.4±0.4；p<0.05），平均1/3 PER值也显著高于对照组（1.7±0.5对1.3±0.5；p<0.05）。14例患者（70%）作为对手握力的反应PER值下降（10例为ACN患者）。ACN患者的平均TES/T值（0.44±0.05）显著高于无ACN的患者（0.38±0.05；p<0.05）。总之，静息时经常检测到舒张功能障碍。ACN患者作为对手握力的反应，收缩参数明显受损。静息时ACN阳性组存在交感神经过度活跃。我们的结果表明，糖尿病合并ACN的患者存在亚临床左心室舒张功能障碍和交感神经过度活跃。
