School of Medicine, The University of Queensland, Brisbane, Queensland, Australia.
JACC Cardiovasc Imaging. 2010 Dec;3(12):1207-15. doi: 10.1016/j.jcmg.2010.09.014.
The purpose of this study was to investigate the independent association between global cardiac autonomic neuropathy (CAN) and left ventricular (LV) dysfunction in addition to regional associations of LV dysinnervation and function, in patients with type 2 diabetes mellitus (T2DM).
CAN represents a potential mechanism in the etiology of nonischemic diabetic cardiomyopathy.
Clinical measures of CAN based on total spectral power of heart rate variability and cardiac reflex testing and echocardiographic assessment of LV function were performed in 118 patients with type 2 diabetes mellitus. Systolic and diastolic function were defined at rest and peak exercise using peak systolic and peak early diastolic (Em) tissue velocities, calculated in 6 basal- and mid-segments using color tissue Doppler. Iodine 123-metaiodobenzylguanidine imaging was performed in 33 patients to directly quantify global (heart/mediastinum ratio) and regional LV sympathetic integrity.
Patients with CAN demonstrated higher resting heart rate, systolic and mean blood pressures, aortic stiffness, hemoglobin A(1c), and urine albumin/creatinine ratio, in addition to lower peak heart rate, chronotropic index, and exercise capacity. Diastolic function (Em) was associated with CAN, evidenced by total spectral power (r = 0.42, p < 0.001) and heart/mediastinum ratio (r = 0.41, p = 0.017). Diastolic function (Em) at rest and systolic function (peak systolic tissue velocity) at rest and exercise were significantly reduced in patients with CAN. Furthermore, total spectral power was associated with Em independent of age, hypertension, metabolic factors, and other relevant contributors to LV dysfunction (β = 0.20, p = 0.035). Relative regional tracer deficits indicative of local denervation were predominant in the anterior and lateral walls (p < 0.001). Associations with regional Em, independent of global iodine 123-metaiodobenzylguanidine uptake, were identified exclusively in mid-anterior (β = 0.45, p = 0.01) and mid-lateral walls (β = 0.34, p = 0.03). However, no association was found between regional denervation and systolic or diastolic dyssynchrony.
The diastolic dysfunction of type 2 diabetes mellitus shows associations with both regional markers of sympathetic integrity and clinical markers of autonomic neuropathy.
本研究旨在探讨 2 型糖尿病患者心脏自主神经病变（CAN）与左心室（LV）功能不全的独立相关性，以及 LV 去神经支配与功能的局部相关性。
CAN 是缺血性糖尿病心肌病发病机制中的一个潜在机制。
对 118 例 2 型糖尿病患者进行基于心率变异性总频谱功率和心脏反射试验的临床 CAN 测量，以及使用彩色组织多普勒在 6 个基底段和中段计算的收缩期和舒张期峰值收缩和峰值早期舒张（Em）组织速度评估 LV 功能。使用碘 123-间碘苄胍成像在 33 例患者中直接定量评估整体（心脏/纵隔比）和局部 LV 交感神经完整性。
CAN 患者的静息心率、收缩压和平均血压、主动脉僵硬度、糖化血红蛋白（HbA1c）和尿白蛋白/肌酐比值较高，而峰值心率、变时指数和运动能力较低。舒张功能（Em）与 CAN 相关，总频谱功率（r = 0.42，p < 0.001）和心脏/纵隔比（r = 0.41，p = 0.017）均有证据表明。CAN 患者的舒张功能（Em）在静息时和收缩功能（静息和运动时的峰值收缩组织速度）均显著降低。此外，总频谱功率与 Em 相关，独立于年龄、高血压、代谢因素和其他导致 LV 功能障碍的相关因素（β = 0.20，p = 0.035）。局部去神经支配的相对区域性示踪剂缺陷主要在前壁和外侧壁（p < 0.001）。与整体碘 123-间碘苄胍摄取无关的局部 Em 相关性仅在前中部（β = 0.45，p = 0.01）和中部外侧壁（β = 0.34，p = 0.03）中被识别。然而，局部去神经支配与收缩期或舒张期不同步之间未发现相关性。
2 型糖尿病的舒张功能障碍与交感神经完整性的局部标志物和自主神经病变的临床标志物均相关。
