Li Chun-Mei, Bai Wen-Juan, Liu Yan-Ting, Tang Hong, Rao Li
Department of Cardiology, West China Hospital of Sichuan University, 37 Guo Xue Xiang, Chengdu, Sichuan, 610041, China.
Int J Cardiovasc Imaging. 2017 Aug;33(8):1151-1158. doi: 10.1007/s10554-017-1100-8. Epub 2017 Mar 15.
Diabetes mellitus (DM) is related to increased risks of cardiovascular diseases, such as myocardial infarction, diabetic cardiomyopathy and secondary hypertension. Dissipative energy loss (EL) derived from vector flow mapping (VFM) is thought to reflect the efficiency of blood flow and has been deemed to be an index for the evaluation of left ventricular function. Our study aimed to investigate the value of dissipative EL in diabetic patients with controlled and uncontrolled blood glucose by VFM. Eighty-eight patients with DM and 58 age-matched healthy controls were recruited. All of the patients received echocardiography examinations. VFM analyses were executed to calculate the EL values according to the apical four-chamber examinations from the left ventricle (LV) view. Our results showed that diastolic EL was compromised in the controlled-blood glucose (59.19 mV/m vs. 32.68 mV/m, p = 0.039) patients and was more dramatically increased in the uncontrolled blood glucose group (88.84 mV/m vs. 32.68 mV/m, p < 0.001) compared with the healthy controls. The impairment of systolic EL was observed only in the uncontrolled blood glucose patients (39.65 mV/m vs. 20.29 mV/m, p < 0.001) and not in the controlled blood glucose patients (29.25 mV/m vs. 20.29 mV/m, p = 0.072). Multivariate backward stepwise linear regression analysis revealed that the HbA1c level was independently related to the diastolic EL (β = 0.233, p = 0.026) and systolic EL (β = 0.237, p = 0.023). VFM is feasible and reproducible for assessing LV dissipative EL in DM patients with normal LVEF values in whom diastolic EL may be a more vulnerable indicator of early LV cardiac dysfunction in patients with DM. However, LV systolic EL may be a sensitive indicator of preclinical LV dysfunction for patients with DM with uncontrolled blood glucose levels. Uncontrolled blood glucose, which is independently correlated with subclinical LV dysfunction, may lead to increases in systolic EL and diastolic EL in LV.
糖尿病（DM）与心血管疾病风险增加有关，如心肌梗死、糖尿病性心肌病和继发性高血压。基于向量血流图（VFM）得出的耗散能量损失（EL）被认为可反映血流效率，并被视为评估左心室功能的一个指标。我们的研究旨在通过VFM研究耗散EL在血糖控制良好和控制不佳的糖尿病患者中的价值。招募了88例糖尿病患者和58例年龄匹配的健康对照者。所有患者均接受了超声心动图检查。根据左心室（LV）视图的心尖四腔心检查执行VFM分析以计算EL值。我们的结果表明，血糖控制良好的患者（59.19mV/m对32.68mV/m，p = 0.039）舒张期EL受损，与健康对照相比，血糖控制不佳组（88.84mV/m对32.68mV/m，p < 0.001）舒张期EL增加更为显著。仅在血糖控制不佳的患者中观察到收缩期EL受损（39.65mV/m对20.29mV/m，p < 0.001），而在血糖控制良好的患者中未观察到（29.25mV/m对20.29mV/m，p = 0.072）。多变量向后逐步线性回归分析显示，糖化血红蛋白水平与舒张期EL（β = 0.233，p = 0.026）和收缩期EL（β = 0.237，p = 0.023）独立相关。对于左心室射血分数（LVEF）值正常的糖尿病患者，VFM在评估左心室耗散EL方面是可行且可重复的，其中舒张期EL可能是糖尿病患者早期左心室心脏功能障碍更敏感的指标。然而，对于血糖控制不佳的糖尿病患者，左心室收缩期EL可能是临床前左心室功能障碍的敏感指标。不受控制的血糖与亚临床左心室功能障碍独立相关，可能导致左心室收缩期EL和舒张期EL增加。
