Division of Cardiology, Department of Medicine, College of Physicians and Surgeons, Columbia University, PH3-342 630 West 168th Street, New York, NY 10032, USA.
Eur J Heart Fail. 2010 May;12(5):454-61. doi: 10.1093/eurjhf/hfq022. Epub 2010 Mar 7.
To assess the independent and combined effects of diabetes and hypertension on left ventricular (LV) diastolic function in a community-based cohort at high cardiovascular risk.
Two-dimensional echocardiography was performed in 708 subjects from the Cardiac Abnormalities and Brain Lesions (CABL) study. Peak diastolic early (E) and late (A) transmitral flow, and tissue Doppler-derived early mitral annulus velocity (E') were recorded, and E/A and E/E' ratios were calculated. The population was divided into four groups: those without hypertension or diabetes (HT-/DM-), those with only hypertension (HT), only diabetes (DM), and with hypertension plus diabetes (HT + DM). In multivariate analysis, hypertension and diabetes were independent predictors of worse diastolic function. The coexistence of hypertension and diabetes was associated with greater impairment of diastolic function (higher E/E' ratio than HT-/DM-, HT, or DM, all P < 0.05), independent of covariates. The negative, synergistic effect of hypertension and diabetes on LV diastolic function was present both in lean participants and in overweight/obese ones. An E/E' ratio >15, suggestive of increased LV filling pressure, was found in 2.2% of HT-/DM-, 8.9% of HT, 5.9% of DM, and 14.7% of HT + DM (P < 0.01).
Hypertension and diabetes are independently associated with impaired LV diastolic function, independent of the effect of overweight/obesity and other covariates. Their coexistence results in a negative synergistic effect on LV diastolic mechanics and is associated with higher LV filling pressures than either condition alone.
在心血管风险较高的社区人群中，评估糖尿病和高血压对左心室（LV）舒张功能的独立和联合影响。
在心脏异常和脑部病变（CABL）研究中对 708 例患者进行二维超声心动图检查。记录二尖瓣口舒张早期（E）和晚期（A）峰血流，组织多普勒衍生的二尖瓣环早期运动速度（E'），并计算 E/A 和 E/E'比值。人群分为四组：无高血压或糖尿病（HT-/DM-）、仅有高血压（HT）、仅有糖尿病（DM）和高血压加糖尿病（HT + DM）。多变量分析显示，高血压和糖尿病是舒张功能障碍的独立预测因素。高血压和糖尿病并存与舒张功能障碍更严重相关（E/E'比值高于 HT-/DM-、HT 或 DM，均 P < 0.05），且不受协变量影响。高血压和糖尿病对 LV 舒张功能的负面协同作用在瘦体重和超重/肥胖者中均存在。E/E'比值>15，提示 LV 充盈压升高，HT-/DM-组为 2.2%、HT 组为 8.9%、DM 组为 5.9%、HT + DM 组为 14.7%（P < 0.01）。
高血压和糖尿病与 LV 舒张功能障碍独立相关，不受超重/肥胖和其他协变量的影响。它们的共存对 LV 舒张力学产生负协同作用，并与单独存在任一条件相比导致更高的 LV 充盈压。
