Kaushik Atul, Kapoor Aditya, Dabadghao Preeti, Khanna Roopali, Kumar Sudeep, Garg Naveen, Tewari Satyendra, Goel Pravin K, Sinha Archana
Department of Cardiology, AIIMS, Jodhpur, Rajasthan, India.
Department of Cardiology, SGPGIMS, Lucknow, Uttar Pradesh, India.
Ann Pediatr Cardiol. 2021 Jan-Mar;14(1):1-9. doi: 10.4103/apc.APC_158_19. Epub 2021 Jan 4.
Subtle structural and functional changes may precede the onset of overt global left ventricular (LV) dysfunction. Data pertaining to tissue velocity imaging (TVI)and strain imaging to assess regional myocardial function and flow mediated vasodilatation are limited in young patients with diabetes.
Conventional echocardiography, TVI parameters along with strain (S), and strain rate (SR) were measured in 50 young diabetics (15.16 ± 2.95 years, mean HBA1c 8.15 ± 1.37 g %) and 25 controls (15.60 ± 2.51 years). Flow-mediated dilation (FMD), nitrate--mediated dilatation (NMD), and carotid intima-media thickness were also assessed.
Conventional echocardiography parameters were similar in patients and controls; however, deceleration time of the mitral inflow velocity (early deceleration time) was significantly shorter in patients when compared with controls (149.06 ± 31.66 vs. 184.56 ± 19.27 ms, =0.001). Patients had lower strain values at the basal lateral LV (21.39 ± 4.12 vs. 23.78 ± 2.02; =0.001), mid-lateral LV (21.43 ± 4.27 vs. 23.17 ± 1.92 =0.02), basal septum (20.59 ± 5.28 vs. 22.91 ± 2.00; = 0.01), and midseptum (22.06 ± 4.75 vs. 24.10 ± 1.99; = 0.01) as compared to controls. SR at the basal and midsegments of the lateral LV wall and at the basal septum was also significantly lower in diabetic patients. Diabetic children also had endothelial dysfunction with significantly lower FMD (8.36 ± 4.27 vs. 10.57 ± 4.12, = 0.04).
LV strain indices and flow--mediated dilatation are impaired in asymptomatic children and adolescents with type 1 diabetes mellitus despite absence of overt heart failure and normal ejection fraction. Early detection of subclinical regional myocardial dysfunction by deformation analysis including strain and strain rate may be useful in the asymptomatic diabetic population.
在明显的全球左心室（LV）功能障碍发作之前，可能先出现细微的结构和功能变化。在患有糖尿病的年轻患者中，有关组织速度成像（TVI）和应变成像以评估局部心肌功能以及血流介导的血管舒张的数据有限。
对50名年轻糖尿病患者（15.16±2.95岁，平均糖化血红蛋白8.15±1.37 g%）和25名对照者（15.60±2.51岁）进行了常规超声心动图检查、TVI参数以及应变（S）和应变率（SR）的测量。还评估了血流介导的扩张（FMD）、硝酸盐介导的扩张（NMD）和颈动脉内膜中层厚度。
患者和对照者的常规超声心动图参数相似；然而，与对照者相比，患者二尖瓣流入速度的减速时间（早期减速时间）明显更短（149.06±31.66 vs. 184.56±19.27 ms，P = 0.001）。与对照者相比，患者左心室基底外侧（21.39±4.12 vs. 23.78±2.02；P = 0.001）、左心室中外侧（21.43±4.27 vs. 23.17±1.92，P = 0.02）、基底室间隔（20.59±5.28 vs. 22.91±2.00；P = 0.01）和中室间隔（22.06±4.75 vs. 24.10±1.99；P = 0.01）的应变值较低。糖尿病患者左心室外侧壁基底和中间节段以及基底室间隔的SR也明显较低。糖尿病儿童还存在内皮功能障碍，FMD明显较低（8.36±4.27 vs. 10.57±4.12，P = 0.04）。
在无症状的1型糖尿病儿童和青少年中，尽管没有明显的心力衰竭且射血分数正常，但左心室应变指标和血流介导的扩张仍受损。通过包括应变和应变率在内的变形分析早期检测亚临床局部心肌功能障碍，可能对无症状糖尿病患者群体有用。
