Zarich S W, Arbuckle B E, Cohen L R, Roberts M, Nesto R W
Section of Cardiology, New England Deaconess Hospital, Boston, Massachusetts 02215.
J Am Coll Cardiol. 1988 Jul;12(1):114-20. doi: 10.1016/0735-1097(88)90364-6.
Indexes of left ventricular diastolic filling were measured by pulsed Doppler echocardiography in 21 insulin-dependent diabetic patients and 21 control subjects without clinical evidence of heart disease. No patient had chest pain or electrocardiographic changes during exercise testing. The mean age of patients was 32 years. All patients had a normal ejection fraction. Six (29%) of the 21 diabetic patients had evidence of diastolic dysfunction as assessed by the presence of at least two abnormal variables of mitral inflow velocity. The ratio of peak early to peak late (atrial) filling velocity was significantly decreased in diabetic compared with control subjects (1.24 +/- 0.21 versus 1.66 +/- 0.30, p. less than 0.001). Atrial filling velocity was significantly increased in diabetic patients (74.3 +/- 16.7 versus 60.3 +/- 12.2 cm/s, p less than 0.004), whereas early filling velocity was reduced by a nearly significant degree (88.8 +/- 12.6 versus 98.5 +/- 18.8 cm/s, p less than 0.057). The atrial contribution to stroke volume as assessed by area under the late diastolic filling envelope compared to total diastolic area was also significantly increased in diabetic compared with control subjects (35 versus 27%, p less than 0.001). Left ventricular diastolic filling abnormalities in diabetic patients did not correlate with duration of diabetes, retinopathy, nephropathy or peripheral neuropathy. These data suggest that approximately one-third of such patients have subclinical myocardial dysfunction unrelated to accelerated atherosclerosis. Doppler echocardiography may offer a reliable noninvasive means to assess diastolic function and to follow up diabetic patients serially for any deterioration in cardiac status before the appearance of clinical symptoms.
采用脉冲多普勒超声心动图测量了21例胰岛素依赖型糖尿病患者和21例无心脏病临床证据的对照者的左心室舒张期充盈指标。在运动试验期间，无患者出现胸痛或心电图改变。患者的平均年龄为32岁。所有患者的射血分数均正常。21例糖尿病患者中有6例（29%）存在舒张功能障碍的证据，这是通过二尖瓣流入速度的至少两个异常变量来评估的。与对照者相比，糖尿病患者的早期峰值与晚期（心房）充盈速度之比显著降低（1.24±0.21对1.66±0.30，p<0.001）。糖尿病患者的心房充盈速度显著增加（74.3±16.7对60.3±12.2cm/s，p<0.004），而早期充盈速度降低，程度接近显著（88.8±12.6对98.5±18.8cm/s，p<0.057）。与对照者相比，糖尿病患者中通过舒张晚期充盈包络下面积与总舒张面积之比评估的心房对每搏量的贡献也显著增加（35%对27%，p<0.001）。糖尿病患者的左心室舒张期充盈异常与糖尿病病程、视网膜病变、肾病或周围神经病变无关。这些数据表明，约三分之一的此类患者存在与加速动脉粥样硬化无关的亚临床心肌功能障碍。多普勒超声心动图可能提供一种可靠的非侵入性方法来评估舒张功能，并对糖尿病患者进行连续随访，以便在临床症状出现之前发现心脏状况的任何恶化。
