Diastolic dysfunction and diabetic cardiomyopathy - Evaluation by Doppler echocardiography
Diastolic dysfunction and diabetic cardiomyopathy - Evaluation by Doppler echocardiography
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DOI：
10.1016/j.jacc.2006.07.033
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发表时间：
2006-10-17
影响因子：
24
通讯作者：
Galderisi, Maurizio
中科院分区：
文献类型：
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作者：
Galderisi, Maurizio
多普勒超声心动图在很大程度上有助于显示独特的糖尿病心肌病的存在。多项研究指出，糖尿病 (DM) 患者的中壁收缩力学和左心室舒张期充盈均发生左心室 (LV) 重塑和肥厚，且与同时存在的危险因素无关。新的超声技术将在这一临床环境中取得进一步的进展。二尖瓣环的脉冲组织多普勒研究与透射血流的结合对于获得有关左心室充盈压（LVFP）的信息和揭示多普勒血流伪正常模式（进展为晚期心力衰竭的关键点）可能具有临床价值。在没有心外膜冠状动脉狭窄的情况下，冠状动脉血流储备（CFR）的超声评估可以识别冠状动脉微循环功能障碍，与血糖水平、胰岛素抵抗、交感神经过度兴奋、内皮功能障碍、血管紧张素-肾素系统异常和左心室重构/肥大有关。舒张功能障碍和 CFR 受损可能与 DM 相关，并且可能具有共同的起源。因此，对糖尿病患者进行全面的经胸多普勒评估应包括组织多普勒评估舒张功能和估计左心室功能，以及通过CFR测试评估冠状动脉微血管功能。对于疑似冠状动脉疾病（舒张功能障碍的另一个原因）的患者，需要在压力测试期间对局部室壁运动进行额外分析。
Doppler echocardiography has largely contributed to show the existence of a distinct diabetic cardiomyopathy. Several studies have pointed out the evidence of left ventricular (LV) remodeling and hypertrophy in alterations of both midwall systolic mechanics and LV diastolic filling in diabetes mellitus (DM), independent of the coexistence of concomitant risk factors. Further progress will be provided by new ultrasound technologies in this clinical setting. The combination of pulsed tissue Doppler study of mitral annulus with transmittal inflow may be clinically valuable for obtaining information about left ventricular filling pressure (LVFP) and unmasking Doppler inflow pseudonormal pattern, a hinge point for the progression toward advanced heart failure. In the absence of epicardial coronary artery stenosis, the ultrasound assessment of coronary flow reserve (CFR) may identify the dysfunction of coronary microcirculation, in relation with glycemic levels, insulin resistance, sympathetic overdrive, endothelial dysfunction, abnormalities of the angiotensin-renin system, and LV remodefing/hypertrophy. Diastolic dysfunction and impairment of CFR may be associated in DM, with a likely common origin. In this view, a comprehensive transthoracic Doppler evaluation of diabetic patients should include the assessment of diastolic function and estimation of LVFP by tissue Doppler, and coronary microvascular function by CFR test. Additional analysis of regional wall motion during a stress test would be required in patients with suspected coronary artery disease, another cause of diastolic dysfunction.