在瑞典老年健康人群中，舒张功能恶化与空腹血糖升高及左心室质量增加呈超相加性相关。

Worsening diastolic function is associated with elevated fasting plasma glucose and increased left ventricular mass in a supra-additive fashion in an elderly, healthy, Swedish population.

作者信息

Pareek Manan, Nielsen Mette Lundgren, Gerke Oke, Leósdóttir Margrét, Møller Jacob Eifer, Hindersson Peter, Sehestedt Thomas Berend, Wachtell Kristian, Nilsson Peter M, Olsen Michael Hecht

机构信息

Cardiovascular and Metabolic Preventive Clinic, Department of Endocrinology, Centre for Individualized Medicine in Arterial Diseases (CIMA), Odense University Hospital, Odense, Denmark.

出版信息

Int J Cardiol. 2015 Apr 1;184:466-472. doi: 10.1016/j.ijcard.2015.03.037. Epub 2015 Mar 4.

DOI:10.1016/j.ijcard.2015.03.037

PMID:25756566

Abstract

AIMS

To examine whether increasing fasting plasma glucose (FPG) levels were associated with worsening left ventricular (LV) diastolic function, independently of LV mass index (LVMI) in elderly, otherwise healthy subjects.

METHODS AND RESULTS

We tested cross-sectional associations between echocardiographically determined averaged E/é ratio/diastolic function, LVMI, cardiovascular risk factors, and FPG categorized as normal (NFG), impaired (IFG), and new-onset diabetes mellitus (DM), in 483 men and 208 women aged 56-79 years without overt cardiovascular disease, who received no cardiovascular, anti-diabetic, or lipid-lowering drugs and had a preserved LV ejection fraction >50%. Median E/é was significantly higher among subjects with diabetes than those without (8 vs. 7; p = 0.03), as was the prevalence of grade 2 or 3 diastolic dysfunction (25% vs. 16%; p = 0.02). E/é and diastolic function were significantly associated with LVMI (p ≤ 0.002), but not FPG category, on multivariable analysis. However, interaction analyses revealed that increasing LVMI was primarily associated with worsening diastolic function (higher E/é) in subjects with FPG > 6 mmol/L (β=0.005 for IFG and DM vs. 0.001 for NFG; p = 0.02), whereas increasing systolic blood pressure was primarily associated with worsening diastolic function (higher E/é) in subjects with FPG ≤ 6.9 mmol/L (β = 0.005 for NFG and 0.003 for IFG vs. -0.001 for DM; p=0.001).

CONCLUSION

Diastolic dysfunction was significantly more prevalent among patients with DM than those without. The importance of LVMI increased, but the importance of systolic blood pressure decreased with higher FPG category.

摘要

目的

在老年健康受试者中，研究空腹血糖（FPG）水平升高是否与左心室（LV）舒张功能恶化相关，且独立于左心室质量指数（LVMI）。

方法与结果

我们对483名男性和208名年龄在56 - 79岁、无明显心血管疾病、未服用心血管、抗糖尿病或降脂药物且左心室射血分数>50%的女性进行了超声心动图测定的平均E/é比值/舒张功能、LVMI、心血管危险因素和分为正常（NFG）、受损（IFG）和新发糖尿病（DM）的FPG之间的横断面关联测试。糖尿病患者的E/é中位数显著高于无糖尿病患者（8对7；p = 0.03），2级或3级舒张功能障碍的患病率也是如此（25%对16%；p = 0.02）。多变量分析显示，E/é和舒张功能与LVMI显著相关（p≤0.002），但与FPG类别无关。然而，交互分析显示，LVMI升高主要与FPG>6 mmol/L的受试者舒张功能恶化（E/é升高）相关（IFG和DM的β = 0.005，NFG的β = 0.001；p = 0.02），而收缩压升高主要与FPG≤6.9 mmol/L的受试者舒张功能恶化（E/é升高）相关（NFG的β = 0.005，IFG的β = 0.003，DM的β = -0.001；p = 0.001）。