The Heart Institute, Cincinnati Children's Hospital Medical Center and the Department of Pediatrics, University of Cincinnati, Cincinnati, USA.
Department of Pediatrics, Section of Pediatric Cardiology, Yale University School of Medicine, PO Box 208064, New Haven, CT, 06520-8064, USA.
Cardiovasc Diabetol. 2020 Oct 1;19(1):163. doi: 10.1186/s12933-020-01139-9.
Adults with obesity and type 2 diabetes mellitus (T2DM) related to obesity are at increased risk of heart failure with preserved ejection fraction (HFpEF). Whether left ventricular (LV) diastolic function abnormalities related to obesity and T2DM start in adolescence and early adulthood is unknown. We non-invasively evaluated the differences seen in LV diastolic and left atrial (LA) function in adolescents and young adults with obesity and T2DM.
We analyzed echocardiographic measures of LV diastolic function in patients with structurally normal hearts which were divided into 3 groups (normal weight, obese, and T2DM). Spectral and tissue Doppler and 2-D speckle tracking measurements of diastolic function were obtained. Logistic regression was performed to compare the prevalence of abnormalities in diastolic function based on the worst 25th percentile for each measure to determine the prevalence of diastolic and LA function abnormalities in obese and T2DM patients.
331 teenagers and young adults (median age 22.1 years) were analyzed (101 normal weight, 114 obese, 116 T2DM). Obese and T2DM group had lower E/A and higher E/e'. Obese and T2DM patients had significantly lower atrial reservoir, conduit, and booster strain and worse reservoir and conduit strain rate compared to normal patients (p < 0.001 for all measures). All patients had normal LA volumes. On multivariable analysis, conduit strain and reservoir and conduit strain rate were independently associated with having below the 25th percentile e'. Conduit strain rate was independently associated with having below the 25th percentile for mitral E/A ratio on multivariable analysis.
Abnormal indices of LV diastolic function are detected in adolescents and young adults with obesity and T2DM. LA function and strain analysis were able to detect evidence of decreased reservoir, conduit, and booster strain in these patients although LA volume was normal. The use of LA function strain may increase our ability to detect early diastolic function abnormalities in this population.
肥胖合并 2 型糖尿病（T2DM）的成年人发生射血分数保留型心力衰竭（HFpEF）的风险增加。肥胖和 T2DM 相关的左心室（LV）舒张功能异常是否始于青少年和成年早期尚不清楚。我们采用无创方法评估肥胖和 T2DM 青少年和年轻成年人的 LV 舒张和左心房（LA）功能差异。
我们分析了结构正常心脏的 LV 舒张功能的超声心动图指标，这些患者分为 3 组（正常体重、肥胖和 T2DM）。获得频谱和组织多普勒及二维斑点追踪舒张功能测量值。采用逻辑回归比较根据每个指标最差的 25%分位数比较舒张功能异常的患病率，以确定肥胖和 T2DM 患者舒张和 LA 功能异常的患病率。
共分析了 331 名青少年和年轻成年人（中位年龄 22.1 岁）（101 例正常体重、114 例肥胖、116 例 T2DM）。肥胖和 T2DM 组的 E/A 降低，E/e'升高。与正常组相比，肥胖和 T2DM 患者的心房储备、传导和增强应变降低，储备和传导应变率更差（所有指标均 P < 0.001）。所有患者的 LA 容积均正常。多变量分析显示，传导应变和储备及传导应变率与低于 25%分位数的 e'独立相关。传导应变率与多变量分析中低于 25%分位数的二尖瓣 E/A 比值独立相关。
肥胖合并 T2DM 的青少年和年轻成年人存在异常的 LV 舒张功能指标。尽管 LA 容积正常，但 LA 功能和应变分析能够检测到这些患者储备、传导和增强应变降低的证据。LA 功能应变的应用可能会提高我们在该人群中检测早期舒张功能异常的能力。
