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血压正常的无症状2型糖尿病患者的左心室收缩和舒张功能障碍及其与微血管并发症的关系。

Left ventricular systolic and diastolic dysfunction and their relationship with microvascular complications in normotensive, asymptomatic patients with type 2 diabetes mellitus.

作者信息

Mishra Trinath K, Rath Prabeen K, Mohanty Nirmal K, Mishra Sura K

机构信息

Department of Cardiology, M.K.C.G. Medical College & Hospital, Berhampur, Orissa.

出版信息

Indian Heart J. 2008 Nov-Dec;60(6):548-53.

PMID:19276494

Abstract

OBJECTIVE

Diabetes mellitus is an established risk factor for cardiovascular events. Aims of the study were to assess left ventricular systolic and diastolic function in asymptomatic patients with type 2 diabetes and evaluate the relations among left ventricular function and specific diabetic complications.

METHODS

Seventy-three normotensive patients with type 2 diabetes and no clinical evidence of cardiac disease were studied. Thirty-four healthy subjects served as control group. Echocardiographic studies were performed to assess left ventricular systolic and diastolic function. Microangiopathy was assessed by fundoscopy. Autonomic function was evaluated by standing blood pressure and heart rate response to Valsalva maneuver.

RESULTS

Patients with type 2 diabetes had a lower ejection fraction (54 +/- 10.8 vs. 67 +/- 6.1%, p < or = 0.001), E-velocity (50.1 +/- 10.6 vs. 58.4 +/- 6.3 cm/s, p < or = 0.001), and E/A ratio of <1 (54.8 vs. 5.8%, p < or = 0.01) of the mitral diastolic flow compared with the control subjects, respectively. Patients with ejection fraction <50% had higher prevalence of retinopathy (52.9 vs. 26.7%, p < or = 0.05), abnormal blood pressure response to standing (52.9 vs. 7.1%, p < or = 0.001), and proteinuria (70.5 vs. 14.2%, p < or = 0.05). An inverse correlation was found between duration of diabetes and both ejection fraction (r = -0.53, p = 0.05) and E/A ratio (r = 0.36, p = 0.003). E/A ratio of <1 was associated with higher prevalence of retinopathy (45 vs. 18.1%, p < or = 0.05) and abnormal blood pressure response to standing (25 vs. 9%, p < or = 0.05). Multiple logistic regression model showed that diabetes was the strongest independent correlate of diastolic dysfunction (odds ratio 8.91, 95% CI: 4.18-18.52, p < or = 0.001).

CONCLUSION

Asymptomatic diabetic patients have reduced left ventricular systolic and diastolic function as compared with healthy subjects. Left ventricular systolic and diastolic abnormalities are correlated with the duration of diabetes and with diabetic microangiopathies, like retinopathy and neuropathy. Diabetes mellitus is the strongest independent correlate of left ventricular diastolic dysfunction.

摘要

目的

糖尿病是心血管事件的既定危险因素。本研究的目的是评估无症状2型糖尿病患者的左心室收缩和舒张功能，并评估左心室功能与特定糖尿病并发症之间的关系。

方法

对73例血压正常的2型糖尿病患者进行研究，这些患者无心脏病的临床证据。34名健康受试者作为对照组。进行超声心动图研究以评估左心室收缩和舒张功能。通过眼底镜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。

结果

与对照组相比，2型糖尿病患者的射血分数较低（54±10.8%对67±6.1%，p≤0.001），E波速度较低（50.1±10.6对58.4±6.3cm/s，p≤0.001），二尖瓣舒张期血流的E/A比值<1的比例较高（54.8%对5.8%，p≤0.01）。射血分数<50%的患者视网膜病变患病率较高（52.9%对26.7%，p≤0.05），站立时血压反应异常（52.9%对7.1%，p≤0.001），蛋白尿患病率较高（70.5%对14.2%，p≤0.05）。发现糖尿病病程与射血分数（r=-0.53，p=0.05）和E/A比值（r=0.36，p=0.003）均呈负相关。E/A比值<1与视网膜病变患病率较高（45%对18.1%，p≤0.05）和站立时血压反应异常（25%对9%，p≤0.05）相关。多因素逻辑回归模型显示，糖尿病是舒张功能障碍最强的独立相关因素（比值比8.91，95%可信区间：4.18-18.52，p≤0.001）。