ASL Brindisi, Cardiology Equipe, District of Brindisi, Italy.
Cardiovascular Diseases Section, Department of Emergency and Organ Transplantation (Deto), University of Bari, Italy.
J Diabetes Complications. 2017 Oct;31(10):1533-1537. doi: 10.1016/j.jdiacomp.2017.06.014. Epub 2017 Jul 6.
Coronary artery disease (CAD) is quite common among diabetic patients, our study goal is to detect the prevalence of left ventricular (LV) adverse changes in geometry, mass and diastolic function on diabetic, but not hypertensive patients, with coronary artery disease(CAD) and LV ejection fraction(LVEF)>45%, actually unknown, because of current guidelines that do not include echocardiographic assessment for follow up of diabetic patients.
665 consecutive diabetic patients (443 females, mean age 66±9years), performed a complete echocardiographic assessment according to current ASE echo-guidelines: diastolic dysfunction (DD), eccentric hypertrophy (EH), concentric hypertrophy (CH) and concentric remodeling (CR) of LV were reported. CAD was assessed only by reports of bypass surgery, angioplasty or patients hospitalized for acute myocardial infarction.
218 patients (32.8%) presented LV changes: LVDD 49 (7.4%), LVEH 68 (10.2%), LVDD and EH 46 (6.9%), LVDD and CH 36 (5.4%), LVDD and CR 19 (2.9%). 447 (67.2%) had no LV changes. 81 (12.1%) patients with CAD, presented: LVDD 17 (21%), LVEH 32 (39.5%), LVDD and EH 9 (11.1%), LVDD and CH 7 (8.6%), LVDD and CR 8 (9.9%), 8 (9.9%) had no LV adverse changes. There were among CAD patients, a significantly higher prevalence of LVDD (p<0.02), LV eccentric hypertrophy (EH) (p<0.05), DD and LVEH (p<0.04), DD and LV concentric hypertrophy(CH) (p<0.03) and DD and LV concentric remodeling (p<0.02), when compared with those patients without CAD.
CAD is related to all different patterns of LV adverse changes in mass, geometry and diastolic function, with a significantly higher prevalence in our population of diabetic patients with normal systolic function. These changes however remain unrecognized until they undergo to a conventional echocardiographic assessment. We support this tool need to be included into future guidelines concerning follow-up of diabetic patients.
冠心病（CAD）在糖尿病患者中较为常见，我们的研究目的是检测患有 CAD 但无高血压的糖尿病患者中左心室（LV）不良几何形状、质量和舒张功能变化的发生率，这些患者的 LV 射血分数（LVEF）>45%，目前尚不清楚，因为现行指南不包括超声心动图评估来随访糖尿病患者。
665 例连续的糖尿病患者（443 名女性，平均年龄 66±9 岁），根据当前的 ASE 超声心动图指南进行了完整的超声心动图评估：舒张功能障碍（DD）、偏心性肥厚（EH）、向心性肥厚（CH）和向心性重构（CR）LV 报告。CAD 仅通过旁路手术、血管成形术或因急性心肌梗死住院的患者报告进行评估。
218 例患者（32.8%）出现 LV 变化：LVDD49 例（7.4%），LVEH68 例（10.2%），LVDD 和 EH46 例（6.9%），LVDD 和 CH36 例（5.4%），LVDD 和 CR19 例（2.9%）。447 例（67.2%）患者无 LV 变化。81 例（12.1%）CAD 患者的 LV 变化为：LVDD17 例（21%），LVEH32 例（39.5%），LVDD 和 EH9 例（11.1%），LVDD 和 CH7 例（8.6%），LVDD 和 CR8 例（9.9%），8 例（9.9%）无不良 LV 变化。CAD 患者中，LVDD（p<0.02）、LV 偏心性肥厚（EH）（p<0.05）、DD 和 LVEH（p<0.04）、DD 和 LV 向心性肥厚（CH）（p<0.03）和 DD 和 LV 向心性重构（p<0.02）的发生率显著较高，与无 CAD 的患者相比。
CAD 与 LV 质量、几何形状和舒张功能的所有不同模式的不良变化有关，在我们的 LV 收缩功能正常的糖尿病患者人群中，其发生率显著更高。然而，这些变化在接受常规超声心动图评估之前仍然没有被识别。我们支持将这种工具纳入未来有关糖尿病患者随访的指南。
