Department of Cardiology, Leiden University Medical Center, Postbus 9600, Leiden 2300 RC, the Netherlands.
Eur Heart J Cardiovasc Imaging. 2014 Jan;15(1):41-7. doi: 10.1093/ehjci/jet075. Epub 2013 Jun 21.
Asymptomatic patients with diabetes mellitus (DM) and normal left ventricular (LV) ejection fraction (EF) may have LV dysfunction as assessed with speckle tracking echocardiography. Whether this subtle LV dysfunction may progress or not over time remains unknown. The present evaluation assessed changes in LV function with two-dimensional (2D) speckle tracking analysis in asymptomatic clinically stable patients with type 2 DM and normal LVEF after 2-year follow-up.
A total of 112 asymptomatic patients with type 2 DM and normal LVEF (53 ± 10 years, 59% men) were evaluated. Patients remained clinically stable between baseline and follow-up echocardiography. Conventional and 2D speckle tracking echocardiographic measurements were performed. Circumferential strain (CS) and longitudinal strain (LS) were measured to assess systolic function and strain rate during isovolumetric relaxation time (SR IVR) and peak transmitral early diastolic inflow strain rate (SR E) to assess diastolic function. After 2-year follow-up, a significant increase in the LV mass index and significant decrease in the E/A ratio were observed. Left ventricular ejection fraction remained unchanged (59 to 60%, P = 0.4). In contrast, 2D speckle tracking analysis demonstrated a significant impairment in CS (-19.7 ± 4.0 to -18.9 ± 3.8%, P < 0.001), LS (-17.2 ± 2.3 to -16.9 ± 2.7%, P = 0.022), and SR E (from 1.02 ± 0.28 to 0.94 ± 0.25 S(-1), P < 0.001). After adjusting for changes in the LV mass index, only changes in CS and SR E remained significant (P < 0.001 and P = 0.013, respectively).
Asymptomatic patients with type 2 DM and normal LVEF may show mild progression of subclinical LV function assessed with 2D speckle tracking echocardiography. The prognostic implications of these mild changes warrant prospective evaluation.
患有糖尿病（DM）且左心室（LV）射血分数（EF）正常的无症状患者可能存在 LV 功能障碍，可通过斑点追踪超声心动图评估。这种微妙的 LV 功能障碍是否会随时间进展尚不清楚。本评估在经过 2 年随访后，评估了 112 例无症状、临床稳定的 2 型糖尿病且 LVEF 正常患者的二维（2D）斑点追踪分析的 LV 功能变化。
共评估了 112 例无症状的 2 型糖尿病且 LVEF 正常的患者（53 ± 10 岁，59%为男性）。患者在基线和随访超声心动图检查之间保持临床稳定。进行了常规和 2D 斑点追踪超声心动图测量。测量圆周应变（CS）和纵向应变（LS）以评估收缩功能，并测量等容舒张期时间的应变率（SR IVR）和峰值二尖瓣早期舒张流入应变率（SR E）以评估舒张功能。在 2 年随访后，观察到 LV 质量指数显著增加，E/A 比值显著降低。左心室射血分数保持不变（59%至 60%，P = 0.4）。相反，2D 斑点追踪分析显示 CS（-19.7 ± 4.0 至-18.9 ± 3.8%，P < 0.001）、LS（-17.2 ± 2.3 至-16.9 ± 2.7%，P = 0.022）和 SR E（从 1.02 ± 0.28 至 0.94 ± 0.25 S（-1），P < 0.001）显著受损。调整 LV 质量指数的变化后，仅 CS 和 SR E 的变化具有显著意义（P < 0.001 和 P = 0.013）。
患有 2 型糖尿病且 LVEF 正常的无症状患者可能表现出亚临床 LV 功能的轻度进展，可通过 2D 斑点追踪超声心动图评估。这些轻微变化的预后意义需要前瞻性评估。
