微血管功能障碍在2型糖尿病左心室功能障碍中的作用

Role of microvascular dysfunction in left ventricular dysfunction in type 2 diabetes mellitus.

作者信息

Halabi Amera, Nolan Mark, Potter Elizabeth, Wright Leah, Asham Atef, Marwick Thomas H

机构信息

Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.

Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia; Menzies Institute for Medical Research, Imaging Research, Hobart, Tasmania, Australia.

出版信息

J Diabetes Complications. 2021 May;35(5):107907. doi: 10.1016/j.jdiacomp.2021.107907. Epub 2021 Mar 16.

DOI:10.1016/j.jdiacomp.2021.107907

PMID:33752963

Abstract

BACKGROUND

Although microvascular disease (mVD) has been linked to poor cardiovascular outcomes in diabetes mellitus, the contribution of mVD to diabetic cardiomyopathy (DC) is unexplored. We investigated whether LV systolic and diastolic dysfunction is associated with mVD in T2DM.

METHODS

We recruited 32 asymptomatic patients with T2DM (age 71 ± 4 years, 31% females) from a community-based population. All underwent a comprehensive echocardiogram at baseline including assessment of global longitudinal strain (GLS) and diastolic function. Adenosine stress perfusion on cardiac magnetic resonance imaging (CMR) was performed in all patients. Coronary sinus flow (CSF) was measured offline at rest and peak stress with coronary flow reserve (CFR) calculated as the ratio of global stress and rest CSF.

RESULTS

Resting CSF was reduced in 15 (47%) compared to 4 (13%) with adenosine-stress (p = 0.023). Overall, CFR was observed to be reduced in the cohort (2.38 [IQR 2.20]). Abnormal CFR was not associated with diabetes duration of ≥10 years or poor glycaemic control. CFR was not associated with abnormal GLS (OR 1.04 [95% CI 0.49, 2.20], p = 0.93). However, a modest negative correlation was observed with e' and CFR (r = -0.49, p = 0.004).

CONCLUSION

This pilot study did not show correlation between subclinical systolic dysfunction and a novel MRI biomarker of microvascular disease. However, there was a weak correlation with myocardial relaxation. Confirmation of these findings in larger studies is indicated.

摘要

背景

尽管微血管疾病（mVD）与糖尿病患者不良心血管结局相关，但mVD对糖尿病性心肌病（DC）的影响尚未得到研究。我们调查了2型糖尿病（T2DM）患者左心室收缩和舒张功能障碍是否与mVD有关。

方法

我们从社区人群中招募了32例无症状T2DM患者（年龄71±4岁，31%为女性）。所有患者在基线时均接受了全面的超声心动图检查，包括整体纵向应变（GLS）和舒张功能评估。所有患者均进行了心脏磁共振成像（CMR）腺苷负荷灌注检查。静息和负荷峰值时的冠状窦血流（CSF）离线测量，并计算冠状血流储备（CFR），即整体负荷和静息CSF的比值。

结果

与4例（13%）腺苷负荷时相比，15例（47%）静息时CSF降低（p = 0.023）。总体而言，该队列中观察到CFR降低（2.38[四分位间距2.20]）。异常CFR与糖尿病病程≥10年或血糖控制不佳无关。CFR与异常GLS无关（比值比1.04[95%置信区间0.49，2.20]，p = 0.93）。然而，观察到e'与CFR之间存在适度的负相关（r = -0.49，p = 0.004）。