心脏磁共振容积-时间曲线评估2型糖尿病合并冠状动脉疾病患者的左心室功能障碍
Volume-time curve of cardiac magnetic resonance assessed left ventricular dysfunction in coronary artery disease patients with type 2 diabetes mellitus.
作者信息
Xu Hua-Yan, Yang Zhi-Gang, Guo Ying-Kun, Shi Ke, Liu Xi, Zhang Qin, Jiang Li, Xie Lin-Jun
机构信息
Department of Radiology, National Key Laboratory of Biotherapy, West China Hospital, Sichuan University, # 37Guo Xue Xiang, Chengdu, Sichuan, 610041, China.
Department of Radiology, West China Second University Hospital, Sichuan University, #20, Section 3, Renmin South Road, Chengdu, Sichuan, 610041, China.
出版信息
BMC Cardiovasc Disord. 2017 Jun 5;17(1):145. doi: 10.1186/s12872-017-0583-5.
BACKGROUND
Type 2 diabetes mellitus (DM2) may induce epicardial coronary artery diseases and left ventricular myocardial damaging as well. Left ventricular dysfunction was found in DM2. In this research, we compared the left ventricular dysfunction of coronary artery disease (CAD) patients with and without type 2 diabetes mellitus as well as normal controls using the volume-time curve of cardiac magnetic resonance (CMR).
METHODS
Sixty-one CAD patients (28 with DM2 and 33 without DM2) and 18 normal individuals were enrolled in this study. Left ventricular function parameters, including the end-diastolic and end-systolic volumes (EDV, ESV), stroke volume (SV) and ejection fraction (EF), and morphologic dimension parameters (end diastolic and systolic diameter (EDD and ESD), were measured and compared. Volume-time curve parameters, including the peak ejection rate (PER), peak ejection time (PET), peak filling rate (PFR), peak filling time from ES (PFT), peak ejection rate normalized to EDV (PER/EDV), and peak filling rate normalized to EDV (PFR/EDV), were derived automatically and compared.
RESULTS
LVEF in the diabetic CAD group was markedly reduced when compared to the normal and CAD without DM2 groups (all p < 0.05). LVEDD of the diabetic CAD group was significantly enlarged compared to the normal and non-diabetic CAD groups (all p < 0.05). More importantly, the lowest parameters of the left ventricle volume time curve (i.e., PER, PFR, PER/EDV and PFR/EDV) were obtained in diabetic CAD patients (all p < 0.05). In diabetic CAD patients, logistic regression analysis indicated that PET, PFT and PFR/EDV were independent predictors of left ventricular dysfunction (odds ratio [OR]: 1.1208, 1.0161, and 0.0139, respectively). The sensitivity and specificity of PET were 81.2 and 90%, respectively, when the threshold value was greater than 164.4 msec; for PFT, the sensitivity and specificity were 87.5 and 95.0%, respectively (criterion >166.0 msec). Higher sensitivity (87.5%) and specificity (100.0%) were obtained for PFR/EDV (criterion ≤3.7EDV/s).
CONCLUSIONS
Parameters that are derived from the volume-time curve on CMR, including PET, PFT and PFR/EDV, allow clinicians to predict left ventricular dysfunction in diabetic CAD subjects with a high degree of sensitivity and specificity.
背景
2型糖尿病（DM2）可能诱发心外膜冠状动脉疾病以及左心室心肌损伤。在DM2患者中发现了左心室功能障碍。在本研究中，我们使用心脏磁共振成像（CMR）的容积-时间曲线，比较了合并和不合并2型糖尿病的冠心病（CAD）患者以及正常对照者的左心室功能障碍情况。
方法
本研究纳入了61例CAD患者（28例合并DM2，33例不合并DM2）和18名正常个体。测量并比较左心室功能参数，包括舒张末期和收缩末期容积（EDV、ESV）、每搏输出量（SV）和射血分数（EF），以及形态学尺寸参数（舒张末期和收缩末期直径（EDD和ESD））。自动得出并比较容积-时间曲线参数，包括峰值射血率（PER）、峰值射血时间（PET）、峰值充盈率（PFR）、从收缩末期开始的峰值充盈时间（PFT）、以EDV标准化的峰值射血率（PER/EDV）以及以EDV标准化的峰值充盈率（PFR/EDV）。
结果
与正常组和不合并DM2的CAD组相比，糖尿病合并CAD组的左心室射血分数（LVEF）显著降低（所有p<0.05）。与正常组和非糖尿病CAD组相比，糖尿病合并CAD组的左心室舒张末期内径（LVEDD）显著增大（所有p<0.05）。更重要的是，糖尿病合并CAD患者的左心室容积-时间曲线参数最低（即PER、PFR、PER/EDV和PFR/EDV）（所有p<0.05）。在糖尿病合并CAD患者中，逻辑回归分析表明PET、PFT和PFR/EDV是左心室功能障碍的独立预测因素（优势比[OR]分别为1.1208、1.0161和0.0139）。当阈值大于164.4毫秒时，PET的敏感性和特异性分别为81.2%和90%；对于PFT，敏感性和特异性分别为87.5%和95.0%（标准>166.0毫秒）。PFR/EDV的敏感性（87.5%）和特异性（100.0%）更高（标准≤3.7EDV/s）。
结论
CMR容积-时间曲线上得出的参数，包括PET、PFT和PFR/EDV，使临床医生能够以高度的敏感性和特异性预测糖尿病合并CAD患者的左心室功能障碍。
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