Institute for Heart and Circulation Research, University Witten/Herdecke, Witten, Germany.
Diabet Med. 2011 Mar;28(3):311-8. doi: 10.1111/j.1464-5491.2010.03221.x.
Left ventricular diastolic dysfunction is considered a precursor of diabetic cardiomyopathy, while diabetic cardiovascular autonomic neuropathy is associated with an increased risk of mortality. This study aimed to evaluate the association between left ventricular diastolic dysfunction and cardiovascular autonomic neuropathy, both diagnosed according to the current guidelines.
We evaluated 145 patients referred for an elective coronary angiography, 52 of whom had Type 2 diabetes and 48 had impaired glucose tolerance, while 45 subjects had normal glucose tolerance. Cardiovascular autonomic neuropathy was diagnosed using autonomic function tests, while left ventricular diastolic dysfunction was verified by tissue Doppler imaging echocardiography.
Cardiovascular autonomic neuropathy was diagnosed in 15 (28.8%) patients with Type 2 diabetes and in six (12.5%) individuals with impaired glucose tolerance. The rates of left ventricular diastolic dysfunction were 81 and 33% in patients with and without cardiovascular autonomic neuropathy, respectively (P < 0.001). In the cardiovascular autonomic neuropathy group (n = 21), early diastolic relaxation velocity (Em) was significantly reduced (5.4 ± 0.9 vs. 7.3 ± 2.1 cm/s; P < 0.001) and the E/Em ratio was significantly higher (13.6 ± 4.6 vs. 10.3 ± 3.4 cm/s, P < 0.001) as compared with the group without cardiovascular autonomic neuropathy (n = 79). These findings remained significant after adjustment for age, sex, coronary artery disease, hypertension and HbA(1c) . A severe form of left ventricular diastolic dysfunction was observed in 33 and 15% of patients with and without cardiovascular autonomic neuropathy, respectively (P = 0.001).
Cardiovascular autonomic neuropathy is associated with a higher prevalence and a more severe form of left ventricular diastolic dysfunction in patients with diabetes or impaired glucose tolerance undergoing coronary angiography. Because both cardiovascular autonomic neuropathy and left ventricular diastolic dysfunction are associated with increased cardiovascular morbidity and mortality, screening for patients with left ventricular diastolic dysfunction and cardiovascular autonomic neuropathy with diabetes or impaired glucose tolerance may identify those at high risk.
左心室舒张功能障碍被认为是糖尿病心肌病的前兆，而糖尿病心血管自主神经病变与死亡率增加相关。本研究旨在评估根据现行指南诊断的左心室舒张功能障碍与心血管自主神经病变之间的关系。
我们评估了 145 名因选择性冠状动脉造影而就诊的患者，其中 52 名患有 2 型糖尿病，48 名患有糖耐量受损，45 名患者血糖正常。心血管自主神经病变通过自主功能测试诊断，左心室舒张功能障碍通过组织多普勒成像超声心动图验证。
2 型糖尿病患者中有 15 例（28.8%）和糖耐量受损患者中有 6 例（12.5%）被诊断为心血管自主神经病变。有和没有心血管自主神经病变的患者左心室舒张功能障碍的发生率分别为 81%和 33%（P<0.001）。在心血管自主神经病变组（n=21），早期舒张松弛速度（Em）显著降低（5.4±0.9 比 7.3±2.1cm/s；P<0.001），E/Em 比值显著升高（13.6±4.6 比 10.3±3.4cm/s，P<0.001），与无心血管自主神经病变组（n=79）相比。这些发现在校正年龄、性别、冠状动脉疾病、高血压和 HbA(1c)后仍然显著。在接受冠状动脉造影的糖尿病或糖耐量受损患者中，分别有 33%和 15%的患者存在严重的左心室舒张功能障碍（P=0.001）。
在接受冠状动脉造影的糖尿病或糖耐量受损患者中，心血管自主神经病变与左心室舒张功能障碍的发生率更高、形式更严重。由于心血管自主神经病变和左心室舒张功能障碍均与心血管发病率和死亡率增加相关，因此对患有糖尿病或糖耐量受损的左心室舒张功能障碍和心血管自主神经病变患者进行筛查，可能会发现高风险患者。
