Department of Medicine, Division of Cardiovascular Diseases, Mayo Clinic and Foundation, Rochester, Minnesota 55905, USA.
J Am Coll Cardiol. 2010 Jan 26;55(4):300-5. doi: 10.1016/j.jacc.2009.12.003.
The purpose of this study was to evaluate the outcomes of pre-clinical diastolic dysfunction in diabetic patients.
Studies have reported a high prevalence of pre-clinical diastolic dysfunction among patients with diabetes mellitus.
We identified all diabetic patients with a tissue Doppler imaging assessment of diastolic function in Olmsted County, Minnesota, from 2001 to 2007. Diastolic dysfunction was defined as a passive transmitral left ventricular (LV) inflow velocity to tissue Doppler imaging velocity of the medial mitral annulus during passive filling (E/e') ratio >15. The main outcome was the development of heart failure (HF). Secondary outcomes were the development of atrial fibrillation and death.
Overall, 1,760 diabetic patients with a tissue Doppler echocardiographic assessment of diastolic function were identified; 411 (23%) patients had diastolic dysfunction. Using multivariable Cox's proportional hazard modeling, we determined that for every 1-U increase in the passive transmitral LV inflow velocity to tissue Doppler imaging velocity of the medial mitral annulus during passive filling (E/e') ratio, the hazard ratio (HR) of HF increased by 3% (HR: 1.03; 95% confidence interval [CI]: 1.01 to 1.06; p = 0.006) and that diastolic dysfunction was associated with the subsequent development of HF after adjustment for age, sex, body mass index, hypertension, coronary disease, and echocardiographic parameters (HR: 1.61; 95% CI: 1.17 to 2.20; p = 0.003). The cumulative probability of the development of HF at 5 years for diabetic patients with diastolic dysfunction was 36.9% compared with 16.8% for patients without diastolic dysfunction (p < 0.001). Furthermore, diabetic patients with diastolic dysfunction had a significantly higher mortality rate compared with those without diastolic dysfunction.
We demonstrated that an increase in the passive transmitral LV inflow velocity to tissue Doppler imaging velocity of the medial mitral annulus during passive filling (E/e') ratio in diabetic patients is associated with the subsequent development of HF and increased mortality independent of hypertension, coronary disease, or other echocardiographic parameters.
本研究旨在评估糖尿病患者临床前舒张功能障碍的结局。
研究报告称，糖尿病患者中存在较高比例的临床前舒张功能障碍。
我们在明尼苏达州奥姆斯特德县（Olmsted County）确定了所有在 2001 年至 2007 年间接受组织多普勒成像评估舒张功能的糖尿病患者。舒张功能障碍定义为被动充盈期间左心室（LV）二尖瓣环间隔组织多普勒成像速度与组织多普勒成像速度的比值（E/e'）大于 15。主要结局是心力衰竭（HF）的发生。次要结局为心房颤动和死亡的发生。
总体而言，我们确定了 1760 例接受组织多普勒超声心动图评估舒张功能的糖尿病患者；其中 411 例（23%）患者存在舒张功能障碍。使用多变量 Cox 比例风险模型，我们确定，在被动充盈期间，左心室二尖瓣环间隔组织多普勒成像速度与组织多普勒成像速度的比值每增加 1-U，HF 的风险比（HR）增加 3%（HR：1.03；95%置信区间[CI]：1.01 至 1.06；p = 0.006），并且在调整年龄、性别、体重指数、高血压、冠心病和超声心动图参数后，舒张功能障碍与 HF 的后续发生相关（HR：1.61；95%CI：1.17 至 2.20；p = 0.003）。在 5 年内，有舒张功能障碍的糖尿病患者发生 HF 的累积概率为 36.9%，而无舒张功能障碍的患者为 16.8%（p < 0.001）。此外，与无舒张功能障碍的患者相比，有舒张功能障碍的糖尿病患者死亡率显著更高。
我们证明，糖尿病患者被动充盈期间左心室二尖瓣环间隔组织多普勒成像速度与组织多普勒成像速度的比值（E/e'）增加与 HF 的发生和死亡率增加相关，独立于高血压、冠心病或其他超声心动图参数。
