Di Cori Andrea, Di Bello Vitantonio, Miccoli Roberto, Talini Enrica, Palagi Caterina, Delle Donne Maria Grazia, Penno Giuseppe, Nardi Carmela, Bianchi Cristina, Mariani Mario, Del Prato Stefano, Balbarini Alberto
Cardiac and Thoracic Department, University of Pisa, Pisa, Italy.
Am J Cardiol. 2007 Jan 1;99(1):84-90. doi: 10.1016/j.amjcard.2006.07.063. Epub 2006 Nov 9.
The aim of this study was to determine whether early myocardial structural and functional systolic and diastolic alterations in asymptomatic and uncomplicated patients with type 1 diabetes mellitus (DM) could be detected using the new highly sensitive echocardiographic techniques of integrated backscatter and color Doppler myocardial imaging. Forty asymptomatic and uncomplicated patients with type 1 DM and 40 gender- and age-matched normal controls were studied. All patients were analyzed by conventional and new echocardiographic techniques (integrated backscatter and color Doppler myocardial imaging). Patients with DM showed reduced systolic function compared with controls, evidenced by significantly lower peak strain, strain rates, and cyclic variation indexes at the septum (p <0.0001, <0.01, and <0.001, respectively) and at the posterior wall level (p <0.0001, <0.0001, and <0.001, respectively). On receiver-operating characteristic curve analysis, systolic strain and the cyclic variation index showed the highest discriminating power for separating patients with DM and control subjects. Neither structural or ultrastructural nor diastolic functional abnormalities were detected. On univariate regression analysis, a significant inverse correlation was found for DM duration with conventional (E/A ratio) and unconventional (tissue Doppler imaging E/A ratio) indexes of diastolic function, in the absence of any correlation for systolic function. In conclusion, highly sensitive ultrasonic techniques demonstrate evidence of left ventricular systolic dysfunction in the early stage of type 1 DM, in the absence of ultrastructural and left ventricular diastolic functional abnormalities.
本研究的目的是确定能否使用背向散射积分和彩色多普勒心肌成像等新型高灵敏度超声心动图技术，检测出1型糖尿病（DM）无症状且无并发症患者早期心肌结构及收缩和舒张功能的改变。研究了40例无症状且无并发症的1型糖尿病患者以及40例年龄和性别匹配的正常对照者。所有患者均采用传统及新型超声心动图技术（背向散射积分和彩色多普勒心肌成像）进行分析。与对照组相比，糖尿病患者的收缩功能降低，表现为室间隔处的峰值应变、应变率和周期性变化指数显著降低（分别为p<0.0001、<0.01和<0.001），后壁水平处也有类似情况（分别为p<0.0001、<0.0001和<0.001）。在受试者工作特征曲线分析中，收缩期应变和周期性变化指数在区分糖尿病患者和对照者方面具有最高的鉴别能力。未检测到结构或超微结构以及舒张功能异常。在单因素回归分析中，发现糖尿病病程与舒张功能的传统指标（E/A比值）和非传统指标（组织多普勒成像E/A比值）呈显著负相关，而与收缩功能无任何相关性。总之，高灵敏度超声技术证明，在1型糖尿病早期存在左心室收缩功能障碍，而无超微结构及左心室舒张功能异常。
