2型糖尿病患者左心室舒张功能受损与血糖控制密切相关。
Impaired left ventricular diastolic function in T2DM patients is closely related to glycemic control.
作者信息
Clarke Geoffrey D, Molina-Wilkins Marjorie, Solis-Herrera Carolina, Mendez Verna, Monroy Adriana, Cersosimo Eugenio, Chilton Robert J, Abdul-Ghani Muhammad, DeFronzo Ralph A
机构信息
Department of Radiology Texas Diabetes Institute University of Texas Health Science Center at San Antonio San Antonio TX USA.
Diabetes Division Department of Medicine Texas Diabetes Institute University of Texas Health Science Center at San Antonio San Antonio TX USA.
出版信息
Endocrinol Diabetes Metab. 2018 Apr 6;1(2):e00014. doi: 10.1002/edm2.14. eCollection 2018 Apr.
BACKGROUND
Left ventricular (LV) diastolic dysfunction commonly is observed in individuals with type 2 diabetes mellitus (T2DM). We employed transthoracic echocardiography (TTE) and cardiac magnetic resonance imaging (CMRI) to investigate the hypothesis that LV diastolic dysfunction in T2DM is associated with poor glycemic control.
METHODS
Forty subjects, 21 with normal glucose tolerance (NGT) and 19 with T2DM, were studied with CMRI and TTE to assess LV function. Early-to-late transmitral flow ratio (E/A) and deceleration time (DecT) were assessed with both modalities. Normalized (to body surface area) end-diastolic volume (EDV/BSA) and normalized peak LV filling rate (pLVFR/BSA) were assessed with CMRI. Early transmitral flow velocity to septal velocity (E/e') and isovolumetric relaxation time (IVRT) were measured using TTE. Dimensional parameters were normalized to body surface area (BSA).
RESULTS
CMRI measurements demonstrated impaired E/A (1.13 ± 0.34 vs 1.62 ± 0.42, < .001), increased DecT (174 ± 46 ms vs 146 ± 15, = .005), as well as lower EDV/BSA (63 ± 10 vs 72 ± 9 mL/m, < .01) and pLVFR/BSA (189 ± 46 vs 221 ± 48 mL s m, < .05) in T2DM subjects. TTE measurements revealed lower E/A (1.1 ± 0.4 vs 1.4 ± 0.2, < .001) and E/e' (6.8 ± 1.5 vs 8.7 ± 2.0, < .0001) with higher DecT (203 ± 22 ms vs 179 ± 18, < .001) and IVRT (106 ± 14 ms vs 92 ± 10, < .001) in T2DM. Multiple parameters of LV function: E/A ( = -.50, = .001), E/A ( = -.46, < .005), pLVFR/BSA ( = -.35, < .05), E/e' ( = -.46, < .005), EDV/BSA ( = -.51, < .0001), EDV/BSA ( = -.42, < .01) were negatively correlated with HbA1c. All but E/e' also were inversely correlated with fasting plasma glucose (FPG).
CONCLUSIONS
Impaired LV diastolic function (DF) was found in T2DM subjects with both CMRI and TTE, and multiple LVDF parameters correlated negatively with HbA1c and FPG. These results indicate that impaired LVDF is inversely linked to glycemic control in T2DM patients.
背景
2型糖尿病（T2DM）患者中常见左心室（LV）舒张功能障碍。我们采用经胸超声心动图（TTE）和心脏磁共振成像（CMRI）来研究T2DM患者左心室舒张功能障碍与血糖控制不佳相关这一假说。
方法
对40名受试者进行了研究，其中21名糖耐量正常（NGT），19名患有T2DM，采用CMRI和TTE评估左心室功能。两种检查方法均评估二尖瓣血流早期与晚期比值（E/A）和减速时间（DecT）。CMRI评估标准化（至体表面积）舒张末期容积（EDV/BSA）和标准化左心室峰值充盈率（pLVFR/BSA）。使用TTE测量二尖瓣早期血流速度与室间隔速度比值（E/e'）和等容舒张时间（IVRT）。尺寸参数均根据体表面积（BSA）进行标准化。
结果
CMRI测量结果显示，T2DM患者的E/A受损（1.13±0.34对1.62±0.42，P<0.001），DecT增加（174±46毫秒对146±15，P=0.005），以及EDV/BSA降低（63±10对72±9 mL/m²，P<0.01）和pLVFR/BSA降低（189±46对221±48 mL·s⁻¹·m⁻²，P<0.05）。TTE测量结果显示，T2DM患者的E/A较低（1.1±0.4对1.4±0.2，P<0.001）和E/e'较低（6.8±1.5对8.7±2.0，P<0.0001），而DecT较高（203±22毫秒对179±18，P<0.001）和IVRT较高（106±14毫秒对92±10，P<0.001）。左心室功能的多个参数：E/A（r=-0.50，P=0.001）、E/A（r=-0.46，P<0.005）、pLVFR/BSA（r=-0.35，P<0.05）、E/e'（r=-0.46，P<0.005）、EDV/BSA（r=-0.51，P<0.0001）、EDV/BSA（r=-0.42，P<0.01）与糖化血红蛋白（HbA1c）呈负相关。除E/e'外，所有参数也与空腹血糖（FPG）呈负相关。
结论
CMRI和TTE均发现T2DM患者存在左心室舒张功能（DF）受损，多个左心室舒张功能参数与HbA1c和FPG呈负相关。这些结果表明，T2DM患者左心室舒张功能受损与血糖控制呈负相关。
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