通过心肌形变成像早期检测糖尿病患者一级亲属的左心室功能障碍：内皮糖萼损伤的作用

Early detection of left ventricular dysfunction in first-degree relatives of diabetic patients by myocardial deformation imaging: The role of endothelial glycocalyx damage.

作者信息

Ikonomidis Ignatios, Pavlidis George, Lambadiari Vaia, Kousathana Fotini, Varoudi Maria, Spanoudi Filio, Maratou Eirini, Parissis John, Triantafyllidi Helen, Dimitriadis George, Lekakis John

机构信息

2nd Cardiology Department, Attikon Hospital, National and Kapodistrian University of Athens, Medical School, Greece.

出版信息

Int J Cardiol. 2017 Apr 15;233:105-112. doi: 10.1016/j.ijcard.2017.01.056. Epub 2017 Jan 8.

DOI:10.1016/j.ijcard.2017.01.056

PMID:28096045

Abstract

BACKGROUND

First-degree relatives of type-2 diabetes patients (FDR) present insulin resistance. We investigated whether FDR and dysglycaemic subjects demonstrate abnormal endothelial glycocalyx and LV deformation during postprandial hyperglycemia.

METHODS

We studied 40 FDR with normal oral glucose test (OGTT), 40 subjects with abnormal OGTT (dysglycaemic) and 20 subjects with normal OGTT without parental history of diabetes (normoglycaemic). At 0 and 120min of OGTT we measured: a) LV longitudinal strain (LS) of subendocardial, mid-myocardial and subepicardial layers, global LS (GLS), peak twisting (pTw), untwisting velocity (pUtwVel), by speckle tracking echocardiography b) perfused boundary region (PBR) of the sublingual arterial microvessels; high PBR values represent reduced glycocalyx thickness. Insulin resistance was evaluated using insulin sensitivity index (ISI).

RESULTS

ISI was related with baseline PBR, GLS and pTw in all subjects (p<0.05). Compared to normoglycaemics, FDR and dysglycaemics had higher PBR, lower ISI, GLS (-18.4±2.6 and -16.8±2.0 vs. -19.2±2.4%), subendocardial LS (-19.0±4.2 and -17.9±3.0 vs. -20.1±3.4%), pTw (14.4±4.4 and 15.6±6.4 vs. 16.9±6.5deg) and pUtwVel (p<0.05 for all comparisons). A GLS<-18% identified FDR with LV dysfunction (p=0.016). Post-OGTT, GLS and the subendocardial LS decreased while pTw and pUtwVel increased in FDR and dysglycaemics (p<0.05) indicating prevalence of the motion of the subepicardial over a dysfunctioning subendocardial myocardial helix. Increased PBR was related with impaired deformation markers at baseline and 120min of OGTT (p<0.05).

CONCLUSION

First-degree relatives and dysglycaemics have reduced glycocalyx thickness related with impaired LV longitudinal, twisting-untwisting function. Postprandial hyperglycemia when combined with insulin resistance causes LV longitudinal dysfunction leading to increased LV twisting.

摘要

背景

2型糖尿病患者的一级亲属（FDR）存在胰岛素抵抗。我们研究了FDR和血糖异常受试者在餐后高血糖期间是否表现出异常的内皮糖萼和左心室变形。

方法

我们研究了40名口服葡萄糖耐量试验（OGTT）正常的FDR、40名OGTT异常（血糖异常）的受试者和20名无糖尿病家族史且OGTT正常（血糖正常）的受试者。在OGTT的0分钟和120分钟时，我们测量了：a）通过斑点追踪超声心动图测量心内膜下、心肌中层和心外膜下层的左心室纵向应变（LS）、整体LS（GLS）、峰值扭转（pTw）、解旋速度（pUtwVel）；b）舌下动脉微血管的灌注边界区域（PBR）；高PBR值代表糖萼厚度降低。使用胰岛素敏感性指数（ISI）评估胰岛素抵抗。

结果

在所有受试者中，ISI与基线PBR、GLS和pTw相关（p<0.05）。与血糖正常者相比，FDR和血糖异常者的PBR更高，ISI、GLS（-18.4±2.6和-16.8±2.0 vs. -19.2±2.4%）、心内膜下LS（-19.0±4.2和-17.9±3.0 vs. -20.1±3.4%）、pTw（14.4±4.4和15.6±6.4 vs. 16.9±6.5度）和pUtwVel更低（所有比较p<0.05）。GLS<-18%可识别出存在左心室功能障碍的FDR（p=0.016）。OGTT后，FDR和血糖异常者的GLS和心内膜下LS降低，而pTw和pUtwVel升高（p<0.05），表明心外膜运动占主导地位，超过功能失调的心内膜心肌螺旋。OGTT基线和120分钟时，PBR升高与变形标志物受损相关（p<0.05）。