Ozkan Hakan, Akdemir Sedat, Tiryakioglu Selma, Ari Hasan, Bozat Tahsin
Bahcesehir University, Faculty of Medicine, Department of Cardiology, Istanbul, Turkey.
Bursa Yuksek Ihtisas Hospital, Department of Cardiology, Bursa, Turkey.
Cardiol Res. 2015 Dec;6(6):346-351. doi: 10.14740/cr439w. Epub 2015 Dec 16.
The aim of this study was to evaluate the relationship between changes in diastolic functions during exercise and the exercising capacity in diabetic patients with diastolic dysfunction and to compare them with healthy individuals and diabetic patients without diastolic dysfunction.
Totally 70 patients prospectively were included in the study and three groups were formed. Forty-six diabetic patients were divided into two groups: those with (group 1) and without (group 2) diastolic dysfunction. The control group (group 3) consisted of 24 patients. All patients were subjected to treadmill exercising test. Echocardiographical assessment was made before exercise and immediately after peak exercise.
Exercising time was dramatically decreased in group 1 compared to the other groups (group 1: 396 ± 125 second, group 2: 487 ± 66 second and group 3: 519 ± 102 second). In group 1, the diastolic mitral flow pattern at rest was transformed into pseudo-normal pattern at peak exercise from abnormal relaxation pattern (E/A ratio 0.70 ± 0.11 during rest, 1.02 ± 0.16; P < 0.0001 during peak exercise). Deceleration time (DT) and iso-volumetric relaxation time (IVRT) turned to normal values (DT 238.86 ± 39.48 millisecond during rest and 199.5 ± 23.57 millisecond during peak exercise; P = 0.001, IVRT 102.83 ± 16.22 millisecond during rest and 74.36 ± 8.67 millisecond during peak exercise; P = 0.001). In groups 2 and 3, the mitral flow pattern, DT and IVRT remained within normal limits during rest and exercise. E/Em ratio, which is one of the parameters of tissue Doppler, increased during peak exercise in the diabetic group with diastolic dysfunction (E/Em ratio 7.85 ± 3.31 during rest and 11.14 ± 3.40 after peak exercise; P < 0.0001).
Diabetic patients with diastolic dysfunction demonstrated a reduced exercise capacity, which may be due to aggravation of pre-existing left ventricular dysfunction.
本研究旨在评估舒张功能不全的糖尿病患者运动期间舒张功能变化与运动能力之间的关系，并将其与健康个体以及无舒张功能不全的糖尿病患者进行比较。
本研究前瞻性纳入了70例患者，并分为三组。46例糖尿病患者被分为两组：有舒张功能不全的患者（第1组）和无舒张功能不全的患者（第2组）。对照组（第3组）由24例患者组成。所有患者均接受了平板运动试验。在运动前和运动峰值后立即进行超声心动图评估。
与其他组相比，第1组的运动时间显著缩短（第1组：396±125秒，第2组：487±66秒，第3组：519±102秒）。在第1组中，静息时二尖瓣舒张期血流模式从异常松弛模式转变为运动峰值时的伪正常模式（静息时E/A比值为0.70±0.11，运动峰值时为1.02±0.16；P<0.0001）。减速时间（DT）和等容舒张时间（IVRT）恢复到正常范围（静息时DT为238.86±39.48毫秒，运动峰值时为199.5±23.57毫秒；P=0.001，静息时IVRT为102.83±16.22毫秒，运动峰值时为74.36±8.67毫秒；P=0.001）。在第2组和第3组中，二尖瓣血流模式、DT和IVRT在静息和运动期间均保持在正常范围内。组织多普勒参数之一的E/Em比值在有舒张功能不全的糖尿病组运动峰值时升高（静息时E/Em比值为7.85±3.31，运动峰值后为11.14±3.40；P<0.0001）。
舒张功能不全的糖尿病患者运动能力降低，这可能是由于原有左心室功能不全加重所致。
