糖尿病对慢性原发性二尖瓣反流患者左心室重构的不良影响。

Adverse impact of diabetes mellitus on left ventricular remodelling in patients with chronic primary mitral regurgitation.

机构信息

Cardiac Ultrasound Laboratory and Cardiovascular Research Center, Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston MA 02114, USA; DHU Ageing-Thorax-Vessel-Blood, hôpital Henri-Mondor, Assistance Publique-hôpitaux de Paris, 94010 Créteil, France.

Cardiac Ultrasound Laboratory and Cardiovascular Research Center, Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston MA 02114, USA; Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart & Lung Institute, Department of Medicine, Laval University, Québec City G1V 0A6, Québec, Canada.

出版信息

Arch Cardiovasc Dis. 2018 Aug-Sep;111(8-9):487-496. doi: 10.1016/j.acvd.2017.10.004. Epub 2018 Jan 3.

DOI:10.1016/j.acvd.2017.10.004

PMID:29306705

Abstract

BACKGROUND

Diabetes mellitus (DM) has an impact on left ventricular (LV) geometry and function, and is associated with worsening of pressure-overload LV remodelling; however, its impact on volume-overload LV remodelling is unknown.

AIM

The objective of the study was to examine the association between DM and LV remodelling in patients with chronic mitral regurgitation (MR) caused by mitral valve prolapse.

METHODS

During a median follow-up of 3.26 [interquartile range 1.59-6.06] years, we evaluated the evolution of echocardiographic variables in 375 consecutive patients, including 61 (16%) patients with DM. The main endpoint was LV remodelling evaluated by LV end-diastolic diameter (LVEDD) and LV mass index increase. LV end-systolic diameter (LVESD) and ejection fraction (LVEF) were also evaluated.

RESULTS

Patients with DM increased their LVEDD more than patients without DM (1.98±4.1 vs 0.15±4.54mm/year of follow-up; P=0.002). LVEF remained stable in the two groups. After adjustment for potential confounders, including age, sex, hypertension, body mass index, MR severity, medications and follow-up duration, DM remained independently associated with LVEDD increase (β=2.30; P<0.001). When comparing patients with DM with patients without DM matched for age, sex and LVEDD at baseline, DM was independently associated with increased LVEDD (β=2.14; P=0.002), LV mass index (β=10.7; P=0.004) and LVESD (β=2.07; P=0.01).

CONCLUSION

DM is associated with worsening of LV remodelling in patients with moderate or severe chronic MR caused by mitral valve prolapse.

摘要

背景

糖尿病（DM）会影响左心室（LV）的几何形状和功能，并与压力超负荷导致的 LV 重构恶化相关；然而，其对容量超负荷导致的 LV 重构的影响尚不清楚。

目的

本研究旨在探讨 2 型糖尿病与二尖瓣脱垂引起的慢性二尖瓣反流（MR）患者 LV 重构之间的关系。

方法

在中位随访 3.26 年（四分位距 1.59-6.06 年）期间，我们评估了 375 例连续患者的超声心动图变量变化，其中 61 例（16%）患者患有 2 型糖尿病。主要终点是通过左心室舒张末期直径（LVEDD）和左心室质量指数增加评估的 LV 重构。还评估了左心室收缩末期直径（LVESD）和射血分数（LVEF）。

结果

患有 2 型糖尿病的患者的 LVEDD 增加大于没有 2 型糖尿病的患者（2.30mm/年；P<0.001）。两组的 LVEF 保持稳定。在校正潜在混杂因素后，包括年龄、性别、高血压、体重指数、MR 严重程度、药物和随访时间，2 型糖尿病仍然与 LVEDD 增加独立相关（β=2.30；P<0.001）。当比较年龄、性别和基线时 LVEDD 匹配的 2 型糖尿病患者和无 2 型糖尿病患者时，2 型糖尿病与 LVEDD（β=2.14；P=0.002）、LV 质量指数（β=10.7；P=0.004）和 LVESD（β=2.07；P=0.01）的增加独立相关。