Longitudinal Myocardial Strain Alteration Is Associated with Left Ventricular Remodeling in Asymptomatic Patients with Type 2 Diabetes Mellitus
Longitudinal Myocardial Strain Alteration Is Associated with Left Ventricular Remodeling in Asymptomatic Patients with Type 2 Diabetes Mellitus
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DOI：
10.1016/j.echo.2014.01.001
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发表时间：
2014-05-01
影响因子：
6.5
通讯作者：
Derumeaux, Genevieve
中科院分区：
文献类型：
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作者：
Ernande, Laura;Bergerot, Cyrille;Derumeaux, Genevieve
背景：在正常受试者中，左心室（LV）尺寸已被证明随时间推移而减小，而室壁厚度则增加。本研究的目的是调查一组2型糖尿病患者在3年随访期间的左室重构及其与纵向收缩应变降低的潜在相关性方法：172例无明显心脏病的2型糖尿病患者前瞻性入组，并接受超声心动图斑点超声心动图检查。跟踪成像以评估基线和3年时的总体LV eL。评估了左室构型改变（定义为垂直杆断裂率< 18%）、基线左室构型改变和随时间推移左室重塑之间的关系。基线时，eL改变患者的左室收缩末期容积（28 +/- 11 vs 23 +/- 9 mL，P <0.001）和相对室壁厚度（RWT; 0.44 +/- 0.06 vs 0.40 +/- 0.07，P = 0.008）高于正常左室舒张末期容积（L）患者。在3年随访时，两组的RWT保持稳定。左室容积在eL正常的患者中显著降低，但在eL改变的患者中没有。多因素分析显示eL改变与左室收缩末期容积独立相关（β = 5.0，P = .006）和RWT（β = 0.03，P = 0.03）基线时和LV舒张末期容积的变化（β = 19.1，P = .001）和LV收缩末期容积（beta = 2.6，P = 0.047）。结论：在2型糖尿病患者中，eL改变与RWT和LV容积较高以及LV容积不随时间降低相关，这可能是左心室重构不良的早期征兆（J Am Soc Echocardiogr 2014; 27：479-88.）
Background: In normal subjects, left ventricular (LV) dimensions have been shown to decrease over time, while wall thickness is increasing. The aim of this study was to investigate LV remodeling in a cohort of patients with type 2 diabetes mellitus during a 3-year follow-up period and its potential association with decreased longitudinal systolic strain (epsilon(L)).Methods: One hundred seventy-two patients with type 2 diabetes without overt heart disease were prospectively enrolled and underwent echocardiography with speckle-tracking imaging to assess global LV eL at baseline and at 3 years. The associations between alteration in epsilon(L) (defined as broken vertical bar epsilon(L)broken vertical bar < 18%), LV geometry at baseline, and LV remodeling over time were evaluated.Results: Among the 172 enrolled patients, 154 completed 3-year follow-up. At baseline, patients with eL alteration had higher LV end-systolic volumes (28 +/- 11 vs 23 +/- 9 mL, P < .001) and relative wall thicknesses (RWT; 0.44 +/- 0.06 vs 0.40 +/- 0.07, P = .008) compared with those with normal epsilon(L). At 3-year follow-up, RWTs remained stable in both groups. LV volumes significantly decreased in patients with normal eL but not in patients with eL alteration. Multivariate analysis showed that eL alteration was independently associated with LV end-systolic volume (beta = 5.0, P = .006) and RWT (beta = 0.03, P = .03) at baseline and with changes in both LV end-diastolic volume (beta = 19.1, P = .001) and LV end-systolic volume (beta = 2.6, P = .047) over 3 years.Conclusions: In patients with type 2 diabetes, eL alteration was associated with higher RWT and LV volumes and with the absence of decreases in LV volumes over time, which might be an early sign of adverse LV remodeling. (J Am Soc Echocardiogr 2014; 27: 479-88.)