Department of Coronary Disease, Jagiellonian University School of Medicine, John Paul II Hospital, Prądnicka 80, 31-202, Krakow, Poland,
Acta Diabetol. 2013 Aug;50(4):597-606. doi: 10.1007/s00592-013-0455-0. Epub 2013 Jan 30.
The aim of the study is to evaluate the prevalence and incidence of myocardial dysfunction (MD) and heart failure (HF) in long-lasting (≥10 years) type 1 diabetes without cardiovascular disorders or with hypertension or coronary heart disease (CHD). The study included 1,685 patients with type 1 diabetes (mean baseline age, 51 years; diabetes duration, 36 years). In all patients, echocardiography was performed, NT-proBNP levels were measured, and clinical symptoms were evaluated. A 7-year follow-up was conducted to monitor systolic and diastolic manifestations of MD and HF. At the end of the follow-up period, the prevalence of HF in the entire group was 3.7 %, and the incidence was 0.02 % per year. The prevalence of MD was 14.5 % and the incidence -0.1 % per year. MD and HF were observed only in hypertensive or CHD patients. At baseline, subjects with diastolic HF constituted 85 % of the HF population and those with systolic HF the remaining 15 %. Baseline HF predictors included age, diabetes duration, HbA1c levels, CHD, systolic blood pressure >140 mmHg, and GFR <60 mL/min/1.73 m(2). In patients with type 1 diabetes, MD and HF occurred only when diabetes coexisted with cardiovascular disorders affecting myocardial function. The prevalence and incidence of HF in patients with hypertension and CHD were relatively low. While the cause of this observation remains uncertain, it could probably be explained, at least partially, by the cardioprotective effect of concomitant treatment.
本研究旨在评估无心血管疾病或合并高血压或冠心病的长期（≥10 年）1 型糖尿病患者心肌功能障碍（MD）和心力衰竭（HF）的患病率和发病率。该研究纳入了 1685 名 1 型糖尿病患者（平均基线年龄为 51 岁，糖尿病病程为 36 年）。所有患者均接受了超声心动图检查、NT-proBNP 水平测定和临床症状评估。进行了 7 年的随访以监测 MD 和 HF 的收缩和舒张表现。随访期末，全组 HF 的患病率为 3.7%，发病率为每年 0.02%。MD 的患病率为 14.5%，发病率为每年 0.1%。MD 和 HF 仅见于高血压或 CHD 患者。基线时，舒张性 HF 患者占 HF 人群的 85%，收缩性 HF 患者占 15%。HF 的基线预测因素包括年龄、糖尿病病程、HbA1c 水平、CHD、收缩压＞140mmHg 和 GFR＜60mL/min/1.73m2。在 1 型糖尿病患者中，只有当糖尿病合并影响心肌功能的心血管疾病时才会发生 MD 和 HF。高血压和 CHD 患者的 HF 患病率和发病率相对较低。虽然这种观察结果的原因尚不清楚，但至少可以部分解释为同时进行的治疗具有心脏保护作用。
