Jarnert Christina, Melcher Anders, Caidahl Kenneth, Persson Hans, Rydén Lars, Eriksson Maria J
Cardiology Unit, Department of Medicine, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden.
Eur J Heart Fail. 2008 Nov;10(11):1080-7. doi: 10.1016/j.ejheart.2008.08.012. Epub 2008 Oct 5.
Left ventricular (LV) diastolic dysfunction (DD) is diagnosed by Doppler echocardiography (DE) and Tissue Doppler imaging (TDI). Velocity vector imaging (VVI) evaluates myocardial deformation (strain). We studied left atrial (LA) deformation and volumes by VVI in relation to established Doppler-derived indices of LV diastolic function in diabetic patients.
Using DE and TDI , 87 patients (males 49%; age 60+/-7 years) with type 2 diabetes mellitus were classified as having no (n=60), mild (n=13) or moderate (n=14) DD.
LA volume was larger in moderate (72.3+/-22.4 ml) than in mild DD (58.8+/-16.1 ml; p=0.01) and no DD (57.9+/-16.0 ml; p=0.01). LA roof strain distinguished no DD from mild and moderate DD (p=0.0073). Systolic LA strain correlated to total emptying fraction (r=0.70, p<0.0001), and inversely to LA volume (r=-0.35, p=0.0009). A cross-validated analysis of no versus mild or moderate DD expressed by LA strain revealed a positive predictive value of 48% and negative of 84%.
LA strain by VVI is impaired in patients with type 2 diabetes mellitus and mild or moderate LV DD. LA strain seems of value in distinguishing normal from abnormal diastolic function. VVI offers new information on regional LA function and LA volumes but has too limited discriminative power to detect early LV DD.
左心室舒张功能障碍（DD）通过多普勒超声心动图（DE）和组织多普勒成像（TDI）进行诊断。速度向量成像（VVI）评估心肌变形（应变）。我们通过VVI研究了糖尿病患者左心房（LA）变形和容积与已确立的基于多普勒的左心室舒张功能指标之间的关系。
使用DE和TDI，将87例2型糖尿病患者（男性占49%；年龄60±7岁）分为无舒张功能障碍组（n = 60）、轻度舒张功能障碍组（n = 13）或中度舒张功能障碍组（n = 14）。
中度舒张功能障碍组的左心房容积（72.3±22.4 ml）大于轻度舒张功能障碍组（58.8±16.1 ml；p = 0.01）和无舒张功能障碍组（57.9±16.0 ml；p = 0.01）。左心房顶部应变可区分无舒张功能障碍组与轻度和中度舒张功能障碍组（p = 0.0073）。收缩期左心房应变与总排空分数相关（r = 0.70，p < 0.0001），与左心房容积呈负相关（r = -0.35，p = 0.0009）。对由左心房应变表示的无舒张功能障碍与轻度或中度舒张功能障碍进行交叉验证分析，发现阳性预测值为48%，阴性预测值为84%。
2型糖尿病合并轻度或中度左心室舒张功能障碍患者的VVI左心房应变受损。左心房应变在区分正常与异常舒张功能方面似乎具有价值。VVI提供了关于左心房局部功能和左心房容积的新信息，但检测早期左心室舒张功能障碍的鉴别能力有限。
