Sciatti Edoardo, Vizzardi Enrico, Castiello Assunta, Valentini Francesca, Bonadei Ivano, Gelsomino Sandro, Lorusso Roberto, Metra Marco
Cardiology Unit, University and ASST Spedali Civili, Brescia, Italy.
Department of Cardio-Thoracic Surgery, Cardiovascular Research Institute Maastricht-CARIM, Heart & Vascular Center, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands.
Echocardiography. 2018 Jun;35(6):798-803. doi: 10.1111/echo.13841. Epub 2018 Feb 19.
Hypertension is strongly related to arterial stiffness in a cause-effect fashion. Diabetes mellitus is also thought to determine vascular damage, mostly by means of advanced glycosylation end-products (AGEs). Aim of our study was to study the role of type 2 diabetes mellitus (T2DM) as regard ascending aortic elastic properties in hypertensive patients.
We prospectively enrolled outpatients with hypertension (n = 99) and type 2 diabetes mellitus plus hypertension (n = 42) without cardiovascular events. They underwent a transthoracic echocardiography to measure aortic diameters, aortic elastic properties (ie, compliance, distensibility, stiffness index, Peterson's elastic modulus, pulse wave velocity, M-mode strain), tissue Doppler imaging (TDI) to calculate diastolic (E' and A') and systolic (S') velocities, and tissue strain. Multivariable analysis was run to assess the association between T2DM and these variables after correcting for possible confounders (age, sex, body mass index [BMI], dyslipidemia).
The two groups did not differ as regards age, sex, BMI, and blood pressure. However, T2DM patients were more likely to be dyslipidemic (43% vs 71%, P = .003). Aortic diameters were similar in the two groups, but the aortic elastic properties significantly more impaired in T2DM group. At multivariable analysis, stiffness index, Peterson's elastic modulus, the TDI waves, and the tissue strain remained associated with the co-presence of T2DM and hypertension.
Our data suggest that people suffering from both T2DM and hypertension have more impaired aortic elastic properties than those hypertensive alone. Considering the prognostic role of aortic stiffness, these patients may benefit from a closer follow-up.
高血压与动脉僵硬度存在因果关系。糖尿病也被认为主要通过晚期糖基化终产物（AGEs）导致血管损伤。我们研究的目的是探讨2型糖尿病（T2DM）对高血压患者升主动脉弹性特性的影响。
我们前瞻性纳入了无心血管事件的高血压门诊患者（n = 99）和2型糖尿病合并高血压门诊患者（n = 42）。他们接受经胸超声心动图检查以测量主动脉直径、主动脉弹性特性（即顺应性、扩张性、僵硬度指数、彼得森弹性模量、脉搏波速度、M型应变），组织多普勒成像（TDI）以计算舒张期（E'和A'）和收缩期（S'）速度以及组织应变。在对可能的混杂因素（年龄、性别、体重指数[BMI]、血脂异常）进行校正后，进行多变量分析以评估T2DM与这些变量之间的关联。
两组在年龄、性别、BMI和血压方面无差异。然而，T2DM患者血脂异常的可能性更大（43%对71%，P = 0.003）。两组的主动脉直径相似，但T2DM组的主动脉弹性特性受损更明显。在多变量分析中，僵硬度指数、彼得森弹性模量、TDI波和组织应变仍与T2DM和高血压的共存相关。
我们的数据表明，同时患有T2DM和高血压的患者比单纯高血压患者的主动脉弹性特性受损更严重。考虑到主动脉僵硬度的预后作用，这些患者可能受益于更密切的随访。
