Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Post 835, Kildegårdsvej 28, Hellerup, Denmark.
Institute of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Blegdamsvej 3B, Copenhagen N., Denmark.
Eur Heart J Cardiovasc Imaging. 2018 Sep 1;19(9):1034-1041. doi: 10.1093/ehjci/jex231.
Albuminuria-a marker of generalized vascular dysfunction-is a strong predictor of heart failure in patients with type 2 diabetes which may be caused by concomitant myocardial dysfunction reflecting the same underlying pathogenesis.
We included 915 patients with type 2 diabetes from two secondary care centres and stratified according to albuminuria status in normo-, micro-, and macroalbuminuria. We performed comprehensive echocardiography including conventional imaging, tissue Doppler imaging, and 2D speckle tracking. Cardiac remodelling occurred in patients with increasing left ventricular (LV) mass index and LV wall thicknesses with increasing severity of albuminuria. Diastolic measures worsened across groups of albuminuria severity (normo-, micro-, and macroalbuminuria, respectively): septal e' velocity [mean: 6.9 cm/s (SD 1.9), 6.4 (1.7), and 5.9 (1.7), P < 0.001], septal E/e' (median: 10.6 [interquartile range: 8.9-13.2], 12.1 [10.3-14.8], and 12.7 [10.4-16.6], P < 0.001), and left atrial volume index (24.3 mL/m2 [19.1-29.9], 25.7 [20.0-31.6], and 29.0 [22.2-34.9], P < 0.001) In contrast, systolic measures were only impaired in patients with macroalbuminuria: global longitudinal strain (GLS): [-14.6% (2.7) in normo- and -13.3 (2.9) in macroalbuminuria, P < 0.001] and GLS rate [mean: -0.79 s-1 (0.17) in normo- and -0.72 (0.16) in macroalbuminuria, P = 0.001]. The findings persisted in subgroup analyses of patients without known coronary heart disease and with normal ejection fraction and in multivariable adjusted analyses.
In patients with type 2 diabetes, microalbuminuria is associated with decreased diastolic function whereas decreased systolic function was only associated with macroalbuminuria supporting the notion of similar pathogenic mechanisms of albuminuria and impaired myocardial function.
蛋白尿是全身血管功能障碍的标志物，也是 2 型糖尿病患者心力衰竭的一个强有力的预测因子，这可能是由于同时存在的心肌功能障碍所致，反映了相同的潜在发病机制。
我们纳入了来自两家二级保健中心的 915 名 2 型糖尿病患者，并根据蛋白尿状态分为正常白蛋白尿、微量白蛋白尿和大量白蛋白尿。我们进行了全面的超声心动图检查，包括常规成像、组织多普勒成像和二维斑点追踪。随着左心室（LV）质量指数和 LV 壁厚度的增加，心脏重构发生在蛋白尿程度逐渐加重的患者中。随着蛋白尿严重程度的增加，舒张功能指标恶化（分别为正常白蛋白尿、微量白蛋白尿和大量白蛋白尿）：室间隔 e'速度[平均值：6.9cm/s（标准差 1.9）、6.4（1.7）和 5.9（1.7），P<0.001]、室间隔 E/e'（中位数：10.6[四分位距：8.9-13.2]、12.1[10.3-14.8]和 12.7[10.4-16.6]，P<0.001]和左心房容积指数[24.3ml/m2（19.1-29.9）、25.7（20.0-31.6）和 29.0（22.2-34.9），P<0.001]。相反，只有大量白蛋白尿患者的收缩功能受损：整体纵向应变（GLS）：[正常白蛋白尿时为-14.6%（2.7），大量白蛋白尿时为-13.3%（2.9），P<0.001]和 GLS 率[平均值：正常白蛋白尿时为-0.79s-1（0.17），大量白蛋白尿时为-0.72s-1（0.16），P=0.001]。在没有已知冠心病且射血分数正常的患者亚组分析和多变量校正分析中，这些发现仍然存在。
在 2 型糖尿病患者中，微量白蛋白尿与舒张功能下降有关，而收缩功能下降仅与大量白蛋白尿有关，这支持了白蛋白尿和心肌功能障碍具有相似发病机制的观点。
