Zoppini Giacomo, Bergamini Corinna, Bonapace Stefano, Rossi Andrea, Trombetta Maddalena, Mantovani Alessandro, Toffalini Anna, Lanzoni Laura, Bertolini Lorenzo, Zenari Luciano, Bonora Enzo, Targher Giovanni
Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, Azienda Ospedaliera Universitaria Integrata, University of Verona, Verona, Italy.
Section of Cardiology, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy.
J Diabetes Complications. 2017 Jun;31(6):1035-1040. doi: 10.1016/j.jdiacomp.2017.01.021. Epub 2017 Feb 13.
Type 2 diabetes is strongly associated with the occurrence of cardiovascular diseases, especially heart failure. Some studies have suggested that subclinical systolic dysfunction as assessed by tissue Doppler imaging (TDI) is already present in uncomplicated diabetic patients with normal left ventricular ejection fraction (LVEF). Considering the importance of this aspect, the aim of this cross-sectional study was to examine the relationship between glycated hemoglobin and mean s' wave velocity (a reliable measure of early LV systolic dysfunction) in a cohort of type 2 diabetic outpatients with preserved LVEF and without ischemic heart disease.
Forty-four male patients with newly diagnosed and 172 male patients with established type 2 diabetes were recruited for this cross-sectional study. All patients were evaluated with a transthoracic echocardiographic Doppler. The statistical analysis was conducted by a linear multivariate regression analysis, including several potential confounders.
The mean values of mean s' wave velocity were lower in patients with a worse glycemic control and progressively decreased across the quartiles of glycated hemoglobin. The multivariate linear regression analysis showed that mean s' wave velocity was inversely and independently associated with glycated hemoglobin (standardized beta coefficient -0.178; p = 0.043) after adjustment for age, duration of diabetes, body mass index, pulse pressure, estimated glomerular filtration rate, microvascular complication status, and indexed cardiac mass.
These results suggest that s' wave velocity, as evaluated by TDI echocardiography, was an early marker of systolic dysfunction in type 2 diabetic patients with preserved LVEF and without prior ischemic heart disease. Moreover, early systolic dysfunction was independently associated with poor glycemic control in these patients. Future studies are needed to elucidate the pathogenic role of chronic hyperglycemia in the development of early LV systolic dysfunction.
2型糖尿病与心血管疾病的发生密切相关，尤其是心力衰竭。一些研究表明，经组织多普勒成像（TDI）评估的亚临床收缩功能障碍在左心室射血分数（LVEF）正常的无并发症糖尿病患者中已经存在。鉴于这一方面的重要性，本横断面研究的目的是在一组LVEF保留且无缺血性心脏病的2型糖尿病门诊患者中，研究糖化血红蛋白与平均s'波速度（早期左心室收缩功能障碍的可靠指标）之间的关系。
本横断面研究招募了44例新诊断的男性患者和172例确诊的2型糖尿病男性患者。所有患者均接受经胸超声心动图多普勒检查。通过线性多变量回归分析进行统计分析，包括几个潜在的混杂因素。
血糖控制较差的患者平均s'波速度的平均值较低，且随着糖化血红蛋白四分位数的增加而逐渐降低。多变量线性回归分析显示，在调整年龄、糖尿病病程、体重指数、脉压、估计肾小球滤过率、微血管并发症状态和心脏质量指数后，平均s'波速度与糖化血红蛋白呈负相关且独立相关（标准化β系数-0.178；p = 0.043）。
这些结果表明，经TDI超声心动图评估的s'波速度是LVEF保留且无既往缺血性心脏病的2型糖尿病患者收缩功能障碍的早期标志物。此外，这些患者的早期收缩功能障碍与血糖控制不佳独立相关。未来需要进一步研究以阐明慢性高血糖在早期左心室收缩功能障碍发生发展中的致病作用。
