Tsvetkov Vladimir A, Krutikov Evgeniy S, Chistyakova Svetlana I
V.I. Vernadsky Crimean Federal University, Medical Academy named after S.I. Georgievsky (Academic Unit).
Probl Endokrinol (Mosk). 2020 Aug 4;66(1):56-63. doi: 10.14341/probl12359.
Recent studies have shown a high prevalence of asymptomatic forms of heart failure in patients with type 2 diabetes mellitus. The presence of even subclinical forms of heart failure in type 2 DM is associated with a negative prognosis of the disease, leading to a significant increase in the frequency of hospitalizations and mortality.
Identification of left ventricle subclinical dysfunction in terms of its diastolic function, deformation parameters and rotational properties of the myocardium in patients with type 2 diabetes.
A prospective case-control single-center study, performed simultaneously in groups of patients with type 2 diabetes and hypertension. To identify left ventricular dysfunction (LV), an echocardiographic study was performed, including tissue dopplerography and Speckle Tracking Echocardiography in 2D and 3D modes.
We examined four groups of patients comparable in age and sex distribution, with no obvious clinical signs of heart failure. Group I comprised 56 patients with type 2 diabetes and moderate hypertension. Group II included 52 patients with type 2 diabetes without an increase of blood pressure. Group III (54 people) consisted of patients with essential II degree hypertension without diabetes. Group IV (control) — 30 healthy individuals. The use of tissue dopplerography and Speckle Tracking Echocardiography allows more often (p<0.05) to detect signs of LV dysfunction in patients with type 2 diabetes compared with routine echocardiography methods. It was found that in patients with a combination of type 2 diabetes and moderate hypertension, a prognostically unfavorable restrictive variant of diastolic dysfunction is more common (p<0.05) in contrast to patients with diabetes without hypertension or those with hypertension without diabetes. The combination of type 2 diabetes and hypertension to a greater extent leads to an increase in the longitudinal global deformation of the left ventricle compared with patients who had only one of these diseases (p<0.05). A decrease in the global area strain, an early marker of LV systolic dysfunction, was expressed (p<0.05) in patients with type 2 diabetes, regardless of the presence of concomitant hypertension.
This study shows the importance of using tissue dopplerography and Speckle Tracking Echocardiography in the diagnosis of subclinical heart failure. The results indicate a high prevalence of subclinical systolic-diastolic LV dysfunction in type 2 diabetes, which is aggravated in the presence of concomitant hypertension in patients without obvious clinical signs of heart failure and other cardiovascular diseases.
近期研究表明，2型糖尿病患者中无症状性心力衰竭的患病率很高。2型糖尿病中即使是亚临床形式的心力衰竭也与疾病的不良预后相关，导致住院频率和死亡率显著增加。
根据舒张功能、心肌变形参数和旋转特性，识别2型糖尿病患者左心室亚临床功能障碍。
一项前瞻性病例对照单中心研究，同时在2型糖尿病患者组和高血压患者组中进行。为了识别左心室功能障碍（LV），进行了超声心动图研究，包括组织多普勒成像以及二维和三维模式下的斑点追踪超声心动图。
我们检查了四组年龄和性别分布相当、无明显心力衰竭临床体征的患者。第一组包括56例2型糖尿病合并中度高血压患者。第二组包括52例2型糖尿病且血压未升高的患者。第三组（54人）由原发性II度高血压且无糖尿病的患者组成。第四组（对照组）——30名健康个体。与常规超声心动图方法相比，使用组织多普勒成像和斑点追踪超声心动图更常（p<0.05）检测到2型糖尿病患者的左心室功能障碍迹象。发现与无高血压的糖尿病患者或无糖尿病的高血压患者相比，2型糖尿病合并中度高血压患者中，舒张功能障碍的预后不良的限制性变体更为常见（p<0.05）。与仅患有一种疾病的患者相比，2型糖尿病和高血压的组合在更大程度上导致左心室纵向整体变形增加（p<0.05）。无论是否伴有高血压，2型糖尿病患者中均出现左心室收缩功能障碍的早期标志物——整体面积应变降低（p<0.05）。
本研究表明使用组织多普勒成像和斑点追踪超声心动图在亚临床心力衰竭诊断中的重要性。结果表明，2型糖尿病中亚临床收缩-舒张性左心室功能障碍的患病率很高，在无明显心力衰竭和其他心血管疾病临床体征的患者中，伴有高血压时病情会加重。
