Pham Isabelle, Cosson Emmanuel, Nguyen Minh Tuan, Banu Isabela, Genevois Isabelle, Poignard Patricia, Valensi Paul
Department of Physiology, AP-HP, Jean Verdier Hospital, 93 143 Bondy, France ; Sorbonne Paris Cité-Université Paris 13, UFR SMBH, EA 23-63, 93 017 Bobigny, France.
AP-HP, Jean Verdier Hospital, Department of Endocrinology-Diabetology-Nutrition, Université Paris 13, CRNH-IdF, CINFO, 93 143 Bondy, France ; Sorbonne Paris Cité-Université Paris 13, UMR U1153 Inserm/U1125 Inra/Cnam, 93 017 Bobigny, France.
Int J Endocrinol. 2015;2015:743503. doi: 10.1155/2015/743503. Epub 2015 May 13.
Aim. Our aim was to assess the prevalence of subclinical diabetic cardiomyopathy, occurring among diabetic patients without hypertension or coronary artery disease (CAD). Methods. 656 asymptomatic patients with type 2 diabetes for 14 ± 8 years (359 men, 59.7 ± 8.7 years old, HbA1c 8.7 ± 2.1%) and at least one cardiovascular risk factor had a cardiac echography at rest, a stress cardiac scintigraphy to screen for silent myocardial ischemia (SMI), and, in case of SMI, a coronary angiography to screen for silent CAD. Results. SMI was diagnosed in 206 patients, and 71 of them had CAD. In the 157 patients without hypertension or CAD, left ventricular hypertrophy (LVH: 24.1%) was the most frequent abnormality, followed by left ventricular dilation (8.6%), hypokinesia (5.3%), and systolic dysfunction (3.8%). SMI was independently associated with hypokinesia (odds ratio 14.7 [2.7-81.7], p < 0.01) and systolic dysfunction (OR 114.6 [1.7-7907], p < 0.01), while HbA1c (OR 1.9 [1.1-3.2], p < 0.05) and body mass index (OR 1.6 [1.1-2.4], p < 0.05) were associated with systolic dysfunction. LVH was more prevalent among hypertensive patients and hypokinesia in the patients with CAD. Conclusion. In asymptomatic type 2 diabetic patients, diabetic cardiomyopathy is highly prevalent and is predominantly characterized by LVH. SMI, obesity, and poor glycemic control contribute to structural and functional LV abnormalities.
目的。我们的目的是评估在无高血压或冠状动脉疾病(CAD)的糖尿病患者中发生的亚临床糖尿病性心肌病的患病率。方法。656例无症状的2型糖尿病患者,病程14±8年(359例男性,年龄59.7±8.7岁,糖化血红蛋白8.7±2.1%),且至少有一项心血管危险因素,接受了静息心脏超声检查、用于筛查无症状心肌缺血(SMI)的负荷心脏闪烁扫描,若存在SMI,则进行冠状动脉造影以筛查无症状CAD。结果。206例患者被诊断为SMI,其中71例患有CAD。在157例无高血压或CAD的患者中,左心室肥厚(LVH:24.1%)是最常见的异常,其次是左心室扩张(8.6%)、运动减弱(5.3%)和收缩功能障碍(3.8%)。SMI与运动减弱(优势比14.7 [2.7 - 81.7],p < 0.01)和收缩功能障碍(OR 114.6 [1.7 - 7907],p < 0.01)独立相关,而糖化血红蛋白(OR 1.9 [1.1 - 3.2],p < 0.05)和体重指数(OR 1.6 [1.1 - 2.4],p < 0.05)与收缩功能障碍相关。LVH在高血压患者中更常见,而运动减弱在CAD患者中更常见。结论。在无症状的2型糖尿病患者中,糖尿病性心肌病非常普遍,主要特征为LVH。SMI、肥胖和血糖控制不佳导致左心室结构和功能异常。