Department of Critical Care Medicine and Surgery, Intensive Observation Unit, University of Florence and Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, Florence, Italy.
Int J Cardiovasc Imaging. 2012 Jun;28(5):1023-33. doi: 10.1007/s10554-011-9917-z. Epub 2011 Jul 6.
Prevalence of dynamic left ventricular outflow tract obstruction (DLVO) during dobutamine stress-echo (DSE) seems disproportionally high among diabetic patients. We retrospectively identified 212 diabetic (D+) and 212 non diabetic (D-) subjects, who underwent DSE for suspected coronary artery disease (CAD); we evaluated DSE-induced DLVO prevalence and correlates. During DSE, 105 patients in D+ (50%) and 83 in D- group (39%, P = 0.032) developed a DLVO, with similar maximum gradient (94 ± 49 mmHg in D+ vs. 86 ± 49 mmHg in D-, P = NS). D+ and D- patients with DLVO showed reduced LV end-diastolic and end-systolic dimension. Compared with diabetic subjects without DLVO, diabetic patients with DLVO had higher left ventricular (LV) ejection fraction (EF), lower LV mass index; diastolic function was normal in a higher proportion of cases. Non diabetic patients with moderate or severe DLVO had higher LV EF compared with patients without DLVO. At multivariate analysis, in D+ patients, the only independent predictor was a smaller LV end-diastolic diameter (HR 0.779, CI 0.655-0.926, P = 0.005); in D- patients lower age (HR 0.878, CI 0.806-0.957, P = 0.003), higher LV EF (HR 1.087, CI 1.003-1.177, P = 0.042) and lower peak WMSI (HR 0.017, CI 0.001-0.325, P = 0.007) were associated to presence of DLVO. In D+ patients, during a median follow-up of 924 ± 134 days, we observed 11 new cardiac events, only 1 in patients with DLVO (P = 0.0041). DSE-provoked DLVO had a very high prevalence in patients evaluated for suspected CAD, especially among diabetic patients; echocardiographic predictors were a reduced LV dimension in D+ and a preserved systolic function, both at rest and at peak stress, in D- patients.
在接受多巴酚丁胺负荷超声心动图（DSE）检查的糖尿病患者中，动态左心室流出道梗阻（DLVO）的发生率似乎异常高。我们回顾性地确定了 212 例糖尿病（D+）和 212 例非糖尿病（D-）患者，他们因疑似冠心病（CAD）而行 DSE 检查；我们评估了 DSE 诱导的 DLVO 的发生率和相关因素。在 DSE 期间，D+组中有 105 例（50%）和 D-组中有 83 例（39%，P=0.032）患者出现 DLVO，最大梯度相似（D+组为 94±49mmHg，D-组为 86±49mmHg，P=NS）。D+和 D-患者中，DLVO 与左心室舒张末期和收缩末期内径减小相关。与无 DLVO 的糖尿病患者相比，有 DLVO 的糖尿病患者左心室射血分数（EF）更高，左心室质量指数更低；舒张功能正常的比例更高。非糖尿病患者中，中度或重度 DLVO 患者的左心室 EF 高于无 DLVO 患者。多变量分析显示，在 D+患者中，唯一的独立预测因子是左心室舒张末期直径较小（HR 0.779，CI 0.655-0.926，P=0.005）；在 D-患者中，年龄较小（HR 0.878，CI 0.806-0.957，P=0.003）、左心室 EF 较高（HR 1.087，CI 1.003-1.177，P=0.042）和峰值 WMSI 较低（HR 0.017，CI 0.001-0.325，P=0.007）与 DLVO 的发生相关。在 D+患者中，在中位随访 924±134 天后，我们观察到 11 例新的心脏事件，只有 1 例在有 DLVO 的患者中（P=0.0041）。在疑似 CAD 患者中，DSE 引起的 DLVO 发生率非常高，尤其是在糖尿病患者中；D+患者的超声心动图预测因子为左心室尺寸减小，D-患者的预测因子为静息和峰值负荷时的收缩功能保留，无论左心室 EF 还是峰值 WMSI 都更高。
