Department of Cardiology and Pneumology, University of Goettingen, 37075, Goettingen, Germany.
Diabetologia. 2010 Jul;53(7):1331-40. doi: 10.1007/s00125-010-1718-8. Epub 2010 Apr 13.
AIMS/HYPOTHESIS: Hyperglycaemia and insulin resistance have been linked to diastolic dysfunction experimentally. We investigated the association between glucose metabolism and diastolic function along the whole spectrum of glucose metabolism states.
In the observational Diagnostic Trial on Prevalence and Clinical Course of Diastolic Dysfunction and Diastolic Heart Failure (DIAST-CHF) study, patients with risk factors for heart failure were included. We analysed data including comprehensive echocardiography from a subgroup of patients classified by OGTT and history as normal (n = 343), prediabetic (n = 229) and non-insulin treated (n = 335) or insulin-treated (n = 178) type 2 diabetic.
While ejection fraction did not differ, markers of diastolic function significantly worsened across groups. Prediabetes represented an intermediate between normal glucose metabolism and diabetes with regard to echocardiography changes. Prevalence and severity of diastolic dysfunction increased significantly (p < 0.001) along the diabetic continuum. Glucose metabolism status was significantly associated with prevalence of diastolic dysfunction on multivariate logistic regression analysis. In the whole cohort, HbA(1c) correlated with early diastolic mitral inflow velocity (E):early diastolic tissue Doppler velocity at mitral annulus (e') ratio (E:e') (r = 0.20, p < 0.001). HbA(1c) was significantly associated with E:e' on multivariate analysis. Similarly, glucose metabolism status was significantly associated with E:e' on multivariate analysis. The distance walked in 6 min decreased along the diabetic spectrum and was significantly correlated with E:e' and grade of diastolic dysfunction.
CONCLUSIONS/INTERPRETATION: Glucose metabolism is associated with diastolic dysfunction across the whole spectrum. Our data extend previous observations into the prediabetic and normal range, and may be relevant to preventive approaches, as no effective treatment has been identified for diastolic heart failure once established.
目的/假设：高血糖和胰岛素抵抗与舒张功能障碍在实验中有关。我们研究了葡萄糖代谢与舒张功能之间的关系，涉及整个葡萄糖代谢状态谱。
在观察性诊断试验中，对心力衰竭风险因素的患者进行了包括全面超声心动图的研究。我们分析了 OGTT 和病史分类的患者亚组的数据，分为正常（n=343）、糖尿病前期（n=229）、非胰岛素治疗（n=335）或胰岛素治疗（n=178）2 型糖尿病。
尽管射血分数没有差异，但舒张功能标志物在各组之间明显恶化。糖尿病前期是正常葡萄糖代谢和糖尿病之间的中间状态，与超声心动图变化有关。随着糖尿病的进展，舒张功能障碍的患病率和严重程度显著增加（p<0.001）。葡萄糖代谢状态与多变量逻辑回归分析中的舒张功能障碍患病率显著相关。在整个队列中，HbA1c 与舒张早期二尖瓣血流速度（E）：二尖瓣环舒张早期组织多普勒速度（e'）比值（E:e'）呈正相关（r=0.20，p<0.001）。HbA1c 在多变量分析中与 E:e'显著相关。同样，葡萄糖代谢状态与 E:e'在多变量分析中显著相关。6 分钟步行距离沿糖尿病谱下降，与 E:e'和舒张功能障碍程度显著相关。
结论/解释：葡萄糖代谢与整个谱的舒张功能障碍相关。我们的数据将以前的观察结果扩展到糖尿病前期和正常范围内，这可能与预防方法有关，因为一旦确立了舒张性心力衰竭，就没有有效的治疗方法。
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