2 型糖尿病伴或不伴糖尿病并发症患者的心脏灌注、结构和功能。

Cardiac perfusion, structure, and function in type 2 diabetes mellitus with and without diabetic complications.

机构信息

Department of Cardiology and Endocrinology, Slagelse Hospital, Ingemannsvej 32, 4200 Slagelse, Denmark.

Institute of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Campusvej 55, 5230 Odense, Denmark.

出版信息

Eur Heart J Cardiovasc Imaging. 2020 Aug 1;21(8):887-895. doi: 10.1093/ehjci/jez266.

DOI:10.1093/ehjci/jez266

PMID:31642902

Abstract

AIMS

Coronary microvascular disease (CMD) is a known complication in type 2 diabetes mellitus (T2DM). We examined the relationship between diabetic complications, left ventricular (LV) function and structure and myocardial perfusion reserve (MPR) as indicators of CMD in patients with T2DM and control subjects.

METHODS AND RESULTS

This was a cross-sectional study of 193 patients with T2DM and 25 controls subjects. Patients were grouped as uncomplicated diabetes (n = 71) and diabetes with complications (albuminuria, retinopathy, and autonomic neuropathy). LV structure, function, adenosine stress, and rest myocardial perfusion were evaluated by cardiovascular magnetic resonance. Echocardiography was used to evaluate diastolic function. Patients with uncomplicated T2DM did not have significantly different LV mass and E/e* but decreased MPR (3.8 ± 1.0 vs. 5.1 ± 1.5, P < 0.05) compared with controls. T2DM patients with albuminuria and retinopathy had decreased MPR (albuminuria: 2.4 ± 0.9 and retinopathy 2.6 ± 0.7 vs. 3.8 ± 1.0, P < 0.05 for both) compared with uncomplicated T2DM patients, along with significantly higher LV mass (149 ± 39 and 147 ± 40 vs. 126 ± 33 g, P < 0.05) and E/e* (8.3 ± 2.8 and 8.1 ± 2.2 vs. 7.0 ± 2.5, P < 0.05). When entered in a multiple regression model, reduced MPR was associated with increasing E/e* and albuminuria and retinopathy were associated with reduced MPR.

CONCLUSIONS

Patients with uncomplicated T2DM have reduced MPR compared with control subjects, despite equivalent LV mass and E/e*. T2DM patients with albuminuria or retinopathy have reduced MPR and increased LV mass and E/e* compared with patients with uncomplicated T2DM. E/e* and MPR are significantly associated after adjustment for age, hypertension, and LV mass, suggesting a link between CMD and cardiac diastolic function.

CLINICAL TRIAL REGISTRATION

https://www.clinicaltrials.org. Unique identifier: NCT02684331.

摘要

目的

冠状动脉微血管疾病（CMD）是 2 型糖尿病（T2DM）的已知并发症。我们研究了糖尿病并发症、左心室（LV）功能和结构以及心肌灌注储备（MPR）与 T2DM 患者和对照组 CMD 之间的关系。

方法和结果

这是一项横断面研究，共纳入 193 例 T2DM 患者和 25 例对照组患者。根据是否合并白蛋白尿、视网膜病变和自主神经病变将 T2DM 患者分为单纯糖尿病组（n=71）和合并糖尿病并发症组。采用心血管磁共振评估 LV 结构、功能、腺苷应激和静息心肌灌注，超声心动图评估舒张功能。与对照组相比，单纯 T2DM 患者的 LV 质量和 E/e* 无显著差异，但 MPR 降低（3.8±1.0 比 5.1±1.5，P<0.05）。合并白蛋白尿和视网膜病变的 T2DM 患者的 MPR 降低（白蛋白尿组：2.4±0.9 和视网膜病变组：2.6±0.7，均 P<0.05），LV 质量（白蛋白尿组：149±39 和视网膜病变组：147±40，均 P<0.05）和 E/e*（白蛋白尿组：8.3±2.8 和视网膜病变组：8.1±2.2，均 P<0.05）也升高。多元回归模型分析显示，MPR 降低与 E/e*升高相关，白蛋白尿和视网膜病变与 MPR 降低相关。