Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy.
Diabetic Center, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy.
Diabetes Metab Res Rev. 2022 Feb;38(2):e3484. doi: 10.1002/dmrr.3484. Epub 2021 Jul 14.
Diabetes mellitus (DM) is a risk factor for left ventricle (LV) diastolic dysfunction. Aim of this study was to investigate whether endothelial and/or autonomic dysfunction are associated with LV diastolic dysfunction in DM patients.
We studied 84 non-insulin-dependent type 2 DM (T2DM) patients with no heart disease by assessing: 1) LV diastolic function by echocardiography; 2) peripheral vasodilator function, by measuring flow-mediated dilation (FMD) and nitrate-mediate dilation (NMD); 3) heart rate variability (HRV) on 24-h Holter electrocardiographic monitoring.
Twenty-five patients (29.8%) had normal LV diastolic function, while 47 (55.9%) and 12 (14.3%) showed a mild and moderate/severe diastolic dysfunction, respectively. FMD in these 3 groups was 5.25 ± 2.0, 4.95 ± 1.6 and 4.43 ± 1.8% (p = 0.42), whereas NMD was 10.8 ± 2.3, 8.98 ± 3.0 and 8.82 ± 3.2%, respectively (p = 0.02). HRV variables did not differ among groups. However, the triangular index tended to be lower in patients with moderate/severe diastolic dysfunction (p = 0.09) and a significant correlation was found between the E/e' ratio and both the triangular index (r = -0.26; p = 0.022) and LF amplitude (r = -0.29; p = 0.011).
In T2DM patients an impairment of endothelium-independent, but not endothelium-dependent, dilatation seems associated with LV diastolic dysfunction. The possible role of cardiac autonomic dysfunction in diastolic dysfunction deserves investigation in larger populations of patients.
糖尿病（DM）是左心室（LV）舒张功能障碍的一个危险因素。本研究旨在探讨内皮功能和/或自主神经功能是否与 DM 患者的 LV 舒张功能障碍有关。
我们通过评估以下指标来研究 84 例无心脏病的非胰岛素依赖型 2 型糖尿病（T2DM）患者：1）超声心动图评估 LV 舒张功能；2）血流介导的扩张（FMD）和硝酸盐介导的扩张（NMD）测量外周血管舒张功能；3）24 小时动态心电图监测的心率变异性（HRV）。
25 例（29.8%）患者 LV 舒张功能正常，47 例（55.9%）和 12 例（14.3%）患者分别表现为轻度和中重度舒张功能障碍。这 3 组的 FMD 分别为 5.25±2.0%、4.95±1.6%和 4.43±1.8%（p=0.42），而 NMD 分别为 10.8±2.3%、8.98±3.0%和 8.82±3.2%（p=0.02）。HRV 变量在各组之间没有差异。然而，中度/重度舒张功能障碍患者的三角指数趋于较低（p=0.09），E/e' 比值与三角指数（r=-0.26；p=0.022）和 LF 幅度（r=-0.29；p=0.011）呈显著负相关。
在 T2DM 患者中，内皮非依赖性舒张功能的损害，而不是内皮依赖性舒张功能的损害，似乎与 LV 舒张功能障碍有关。心脏自主神经功能障碍在舒张功能障碍中的可能作用值得在更大的患者人群中进行研究。
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