Zahiti Bedri Faik, Gorani Daut Rashit, Gashi Fitim Bejtullah, Gjoka Sami Bajram, Zahiti Lorita Bedri, Haxhiu Bekim Sylë, Kamberi Lulzim Selim
University Clinical Centre of Kosova , Prishtina, Kosovo.
Acta Inform Med. 2013;21(2):120-3. doi: 10.5455/aim.2013.21.120-123.
NONE DECLARED The aim of the study was detection of diastolic dysfunction of myocardium with Tissue Doppler Imaging (TDI) in asymptomatic type 2 diabetic patients, in five years duration of disease, and normal cardiac function on conventional echocardiography (CE), according to the performance showed on exercise stress test.
We studied 300 patients, of them 150 patients with non-obese, normotensive, uncomplicated type 2 diabetes, in five years duration of disease and 150 healthy control subjects. Of all patients, 100 with type 2 diabetes, and 100 patients from the control group underwent exercise test on a treadmill. All participants underwent both CE and TDI echocardiography. With TDI, lateral E' peak velocity, atrial velocity (A'), their ratio (E'/A') and systolic velocity (S') were measured. Diastolic dysfunction was diagnosed by tissue Doppler imaging, and the following criterion was met: E'/A' ratio <1. Cardiac function with CE was without significant features in the two groups.
Using TDI interrogation, diabetic subjects showed a lower E' velocity (10,75±1,2 vs. 14±3 cm/s, p<0,001), an increased A' velocity (10,65±1,8 vs. 11±3 cm/s, p<0,02), and a reduced E/A ratio (0,82±0,04 vs. 1,17±1,4, p<0,001), S (8.92±3,80 vs. 9,30±3.30 cm/sec); E/A (1,17±0.55, p<0,01). In diabetic patients, after the exercise stress test performance, the myocardial velocity increase is registered for wave E'=1,27 cm/sec (12,01%), for wave A'=1,7 cm/sec (15,9%), reduced ratio E'/A' (0.89±0,1 cm/sec 9,0%) and S'=1,3 cm/sec (14,77%). Whereas, mean myocardial velocity values in examined control group after the exercise stress test were higher as follows: E'=2,7 cm/sec (19%), A'=2,1 cm/sec (14%), E'/A'=0,8 cm/sec (12%), and S'=2,7 cm/sec (18%). Myocardial diastolic dysfunction due to reduced exercise tolerance can be evidenced by TDI in type 2 diabetic subjects, even in the presence of a normal cardiac function with CE and symptom free diabetic patients in rest. Therefore, our findings could justify the use of Tissue Doppler imaging for diastolic function assessment in diabetics with otherwise non significant features on CE.
无申报 本研究的目的是根据运动负荷试验的表现，使用组织多普勒成像（TDI）检测无症状2型糖尿病患者在患病五年且常规超声心动图（CE）显示心脏功能正常时的心肌舒张功能障碍。
我们研究了300名患者，其中150名是非肥胖、血压正常、无并发症的2型糖尿病患者，病程为五年，以及150名健康对照者。所有患者中，100名2型糖尿病患者和100名对照组患者在跑步机上进行了运动试验。所有参与者均接受了CE和TDI超声心动图检查。通过TDI测量了侧壁E'峰值速度、心房速度（A'）、它们的比值（E'/A'）和收缩速度（S'）。通过组织多普勒成像诊断舒张功能障碍，满足以下标准：E'/A'比值<1。两组中CE显示的心脏功能无明显特征。
使用TDI检查，糖尿病患者的E'速度较低（10.75±1.2 vs. 14±3 cm/s，p<0.001），A'速度增加（10.65±1.8 vs. 11±3 cm/s，p<0.02），E/A比值降低（0.82±0.04 vs. 1.17±1.4，p<0.001），S（8.92±3.80 vs. 9.30±3.30 cm/sec）；E/A（1.17±0.55，p<0.01）。在糖尿病患者中，运动负荷试验后，E'波的心肌速度增加为1.27 cm/sec（12.01%），A'波为1.7 cm/sec（15.9%），E'/A'比值降低（0.89±0.1 cm/sec 9.0%），S'为1.3 cm/sec（14.77%）。而在运动负荷试验后，所检查的对照组中的平均心肌速度值更高，如下：E'=2.7 cm/sec（19%），A'=2.1 cm/sec（14%），E'/A'=0.8 cm/sec（12%），S'=2.7 cm/sec（18%）。即使在CE显示心脏功能正常且静息时无症状的糖尿病患者中，TDI也可证明2型糖尿病患者因运动耐量降低导致心肌舒张功能障碍。因此，我们的研究结果可以证明在CE无明显特征的糖尿病患者中使用组织多普勒成像评估舒张功能是合理的。
