Service des Explorations Fonctionnelles Cardiovasculaires, Louis Pradel Hospital, Lyon, France.
J Am Soc Echocardiogr. 2011 Nov;24(11):1268-1275.e1. doi: 10.1016/j.echo.2011.07.017. Epub 2011 Sep 9.
Diastolic dysfunction is considered the first marker of diabetic cardiomyopathy. However, preclinical systolic alteration was also recently described by strain, but its association with diastolic dysfunction has never been investigated.
One hundred fourteen patients with type 2 diabetes mellitus (DM) with controlled blood pressure and without overt heart disease were prospectively enrolled and compared with 88 age-matched controls. All subjects underwent comprehensive echocardiography, including diastolic evaluation according to current recommendations and speckle-tracking imaging. The prevalence of diastolic dysfunction, the determinants of diastolic parameters, and the association between preclinical systolic and diastolic dysfunctions were studied.
Diastolic parameters were altered in patients compared with controls, with lower E/A ratios, longer mitral deceleration and isovolumic relaxation times, and higher E/e' ratio. Diastolic dysfunction occurred in 47% of patients with DM (33% and 14% with grade I and II diastolic dysfunction, respectively) and systolic alteration (longitudinal strain ≥ -18%) in 32% of patients. Whereas longitudinal systolic strain was independently associated with DM and gender, diastolic parameters were influenced by many factors, including age, rate-pressure product, history of hypertension, and body mass index. Systolic alteration occurred in 28% of patients with DM with normal diastolic function and in 35% with diastolic dysfunction.
Diastolic dysfunction diagnosed according to current recommendations is frequent in patients with DM but is also influenced by other factors. Systolic strain alteration may exist despite normal diastolic function, indicating that diastolic dysfunction should not be considered the first marker of a preclinical form of diabetic cardiomyopathy.
舒张功能障碍被认为是糖尿病心肌病的第一个标志物。然而，最近也通过应变描述了临床前收缩改变，但它与舒张功能障碍的关系从未被研究过。
114 例血压控制良好且无明显心脏病的 2 型糖尿病（DM）患者前瞻性纳入并与 88 名年龄匹配的对照组进行比较。所有患者均接受全面超声心动图检查，包括根据当前建议进行的舒张评估和斑点追踪成像。研究了舒张功能障碍的患病率、舒张参数的决定因素以及临床前收缩和舒张功能障碍之间的关系。
与对照组相比，患者的舒张参数发生改变，E/A 比值降低，二尖瓣减速和等容舒张时间延长，E/e'比值升高。DM 患者中出现舒张功能障碍（33%和 14%分别为 I 级和 II 级舒张功能障碍）和收缩改变（纵向应变≥-18%）分别为 47%和 32%。尽管纵向收缩应变与 DM 和性别独立相关，但舒张参数受多种因素影响，包括年龄、心率-血压乘积、高血压病史和体重指数。在舒张功能正常的 DM 患者和舒张功能障碍患者中，分别有 28%和 35%出现收缩改变。
根据当前建议诊断的舒张功能障碍在 DM 患者中很常见，但也受其他因素影响。尽管舒张功能正常，仍可能存在收缩应变改变，这表明舒张功能障碍不应被视为临床前糖尿病心肌病的第一个标志物。
