Novo Giuseppina, Manno Girolamo, Russo Rosario, Buccheri Dario, Dell'Oglio Sonia, Morreale Pierluigi, Evola Giovanna, Vitale Giustina, Novo Salvatore
Department of Cardiology, Paolo Giaccone Hospital, University of Palermo, Italy.
Department of Cardiology, Paolo Giaccone Hospital, University of Palermo, Italy.
Int J Cardiol. 2016 Oct 15;221:1095-9. doi: 10.1016/j.ijcard.2016.07.087. Epub 2016 Jul 10.
Insulin resistance (IR), constitutes an important cardiovascular risk factor and can cause ischemic heart disease. It can lead to left ventricular dysfunction with a mechanism independent of ischemic heart disease and it is closely associated with impaired vascular function. The aim of our study was to explore the impact of IR on cardiac and vascular function, in patients with cardiovascular risk factors but angiographically undamaged coronary arteries.
We studied 32 patients (62.06±11.19years) with cardiovascular risk factors. All patients underwent coronary angiography, echocardiography, Doppler ultrasound of carotid arteries and laboratory tests. Exclusion criteria were coronary artery disease detected by coronary angiography, diabetes mellitus, creatinine above 1.5mg/dl, atrial fibrillation or malignant arrhythmias, left-ventricular hypertrophy, valvular heart disease, ejection fraction below 50%. The presence of insulin resistance was assessed using the Homeostasis Model Assessment of Insulin Resistance (HOMA-IR). Each patient underwent a complete echocardiographic examination including Global Longitudinal Strain assessment and carotid artery ultrasound scan including measurement of arterial stiffness.
The patients were divided into two groups based on the median value of HOMA-IR, the first group for values <4.14 and, the second, for values ≥4.14. Ejection fraction and diastolic function did not significantly differ between the two groups, whether in patients with higher levels of HOMA-IR (≥4.14) we observed a Global Longitudinal Strain (GLS) that was significantly reduced (-16.50±1.37% vs. -20.73±1.84%, p=0.0015) vascular stiffness, measured in the carotid arteries as pulse wave velocity (PWV) (9.70±1.75m/s vs. 7.40±1.89m/s, p=0.00148) that was increased. At multivariate analysis HOMA-IR was an independent predictor of myocardial dysfunction (GLS: coefficient 0.1156, p<0.0001).
Insulin resistance is associated with subclinical myocardial and vascular alterations in patients without significant coronary artery disease, measured as a reduction of Global Longitudinal Strain, and increased arterial stiffness. Our results underscore the importance of studying the interaction between ventricular function and vessels, in the perspective of more effective preventive and therapeutic interventions.
胰岛素抵抗（IR）是一个重要的心血管危险因素，可导致缺血性心脏病。它可导致左心室功能障碍，其机制独立于缺血性心脏病，且与血管功能受损密切相关。我们研究的目的是探讨在有心血管危险因素但冠状动脉造影无损伤的患者中，胰岛素抵抗对心脏和血管功能的影响。
我们研究了32例有心血管危险因素的患者（62.06±11.19岁）。所有患者均接受了冠状动脉造影、超声心动图、颈动脉多普勒超声检查及实验室检查。排除标准为冠状动脉造影检测到的冠状动脉疾病、糖尿病、肌酐高于1.5mg/dl、心房颤动或恶性心律失常、左心室肥厚、心脏瓣膜病、射血分数低于50%。使用胰岛素抵抗稳态模型评估（HOMA-IR）评估胰岛素抵抗的存在情况。每位患者均接受了完整的超声心动图检查，包括整体纵向应变评估，以及颈动脉超声扫描，包括动脉僵硬度测量。
根据HOMA-IR的中位数将患者分为两组，第一组HOMA-IR值<4.14，第二组HOMA-IR值≥4.14。两组间射血分数和舒张功能无显著差异，但是在HOMA-IR水平较高（≥4.14）的患者中，我们观察到整体纵向应变（GLS）显著降低（-16.50±1.37%对-20.73±1.84%，p=0.0015），以颈动脉脉搏波速度（PWV）测量的血管僵硬度增加（9.70±1.75m/s对7.40±1.89m/s，p=0.00148）。多因素分析显示，HOMA-IR是心肌功能障碍（GLS：系数0.1156，p<0.0001）的独立预测因子。
在无明显冠状动脉疾病的患者中，胰岛素抵抗与亚临床心肌和血管改变相关，表现为整体纵向应变降低和动脉僵硬度增加。我们的结果强调了从更有效的预防和治疗干预角度研究心室功能与血管之间相互作用的重要性。
