Department of Cardiology, Medical School, Kafkas University, 36000, Kars, Turkey,
Int J Cardiovasc Imaging. 2014 Jan;30(1):57-65. doi: 10.1007/s10554-013-0296-5. Epub 2013 Oct 6.
We aimed to evaluate the effects of non-dipper BP pattern on left ventricular (LV) rotational mechanics in hypertensive patients with type 2 diabetes mellitus (T2DM) with the utility of two-dimensional speckle tracking echocardiography (2D-STE). Eighty-six hypertensive patients with T2DM were enrolled. All patients underwent 2D-echocardiography and 24-h-ambulatory blood pressure monitoring. Fifty-nine (59.3%) patients had non-dipper BP pattern and all subjects had normal LV function. Patients with non-dipper BP pattern had decreased systolic tissue velocity (p: 0.006), increased peak systolic apical rotation and rotation rate (p: 0.008 and p: 0.014, respectively), and peak LV twist and twist rate (p: 0.005 and p: 0.012, respectively). Analysis of LV diastolic parameters showed that, early diastolic tissue velocity (Em) was decreased and E/Em ratio and LV mass (LVM) index were increased in non-dipper group while the time to LV untwisting rate was delayed. In multivariate analysis, peak LV twist (β = 0.459, p: < 0.001) and twist rate (β = 0.388, p: 0.001) were independently associated with the difference between mean arterial pressure (MAP)-asleep and MAP-awake. In correlation analysis adjusted for age, sex and LVM index, the time to LV untwisting rate was positively correlated with the difference between MAP-asleep and MAP-awake (r: 0.290 vs. p: 0.008) and E/Em ratio (r: 0.280 vs. p: 0.010). LV rotational mechanics are impaired in T2DM non-dipper hypertensive patients, indicating LV systolic and diastolic dysfunction. 2D-STE may permit better understanding of the underlying pathophysiology and development of preventive strategies.
我们旨在通过二维斑点追踪超声心动图（2D-STE）评估 2 型糖尿病伴高血压患者非杓型血压模式对左心室（LV）旋转力学的影响。共纳入 86 例 2 型糖尿病伴高血压患者。所有患者均行 2D 超声心动图和 24 小时动态血压监测。59 例（59.3%）患者存在非杓型血压模式，所有患者均具有正常 LV 功能。非杓型血压模式组患者收缩期组织速度降低（p：0.006），心尖部收缩期峰值旋转和旋转率增加（p：0.008 和 p：0.014），LV 峰值扭转和扭转率增加（p：0.005 和 p：0.012）。LV 舒张参数分析显示，非杓型组患者早期舒张组织速度（Em）降低，E/Em 比值和 LV 质量（LVM）指数增加，而 LV 解旋率时间延迟。多因素分析显示，LV 峰值扭转（β=0.459，p：<0.001）和扭转率（β=0.388，p：<0.001）与 MAP-睡眠与 MAP-清醒之间的差异独立相关。在调整年龄、性别和 LVM 指数后的相关性分析中，LV 解旋率时间与 MAP-睡眠与 MAP-清醒之间的差异呈正相关（r：0.290 vs. p：0.008），与 E/Em 比值呈正相关（r：0.280 vs. p：0.010）。2 型糖尿病非杓型高血压患者 LV 旋转力学受损，提示 LV 收缩和舒张功能障碍。2D-STE 可能有助于更好地了解潜在的病理生理学和制定预防策略。
