Paradoxical increase in ventricular torsion and systolic torsion rate in type I diabetic patients under tight glycemic control
Paradoxical increase in ventricular torsion and systolic torsion rate in type I diabetic patients under tight glycemic control
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DOI：
10.1016/j.jacc.2005.08.061
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发表时间：
2006-01-17
影响因子：
24
通讯作者：
Wickline, SA
中科院分区：
文献类型：
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作者：
Chung, J;Abraszewski, P;Wickline, SA
本研究旨在通过磁共振成像（MRI）taging.Background糖尿病心肌病的早期表现的特点还没有得到很好的建立，特别是在严格的血糖管理。我们假设，扭转测量将确定在I型糖尿病与正常的左心室射血分数，质量，血压，积极血糖控制的亚临床收缩改变。我们还试图描述糖尿病患者的静息心率（HR）升高对torsion. METHODS的影响，16例I型糖尿病患者和10例对照患者进行了电影和标记的MRI与1.5-T扫描仪。测量扭转、应变及其速率。为了量化变时性和变力性刺激对扭转的影响，9名健康志愿者在休息时、注射阿托品后和运动后接受MRI标记。（血红蛋白Ale，6.8 +/- 0.4%）具有较高的静息心率（77.0 +/- 12.4次/分vs. 59.0 +/- 5.6次/分; p < 0.01），最大扭转增加23%（3.5 +/- 0.9度/cm vs. 2.7 +/- 0.4度/cm; p < 0.01）和最大收缩期扭转率（TR-s）提高25%（0.013 +/- 0.003度/cm/s vs. 0.010 +/- 0.002度/cm/s，p = 0.01）。扭转并没有显着改变变时性刺激（p = 0.30）。结论在糖尿病患者严格血糖控制下，我们观察到一个令人惊讶的增加扭转和TR-s无关的变时性影响的HR. We建议，增加扭转和TR-s可以代表早期预测指标的倾向，心功能不全的无症状I型糖尿病患者。此外，这些发现似乎是糖尿病状态本身的基础，而未被其他合并症所解释。
OBJECTIVES This study sought to characterize the early features of diabetic cardiomyopathy by magnetic resonance imaging (MRI) tagging.BACKGROUND The earliest manifestations of diabetic cardiomyopathy have not been well established, especially under tight glycemic management. We hypothesized that torsion measurements would identify subclinical contractile alterations in type I diabetics with normal left ventricular ejection fraction, mass, blood pressure, and aggressive glycemic control. We also sought to characterize the influence of elevated resting heart rates (HRs) of diabetics on torsion.METHODS Sixteen patients with type I diabetes and 10 control patients underwent cine and tagged MRI with a 1.5-T scanner. Torsion, strain, and their rates were measured. To quantify the influence of chronotropic and inotropic stimulation on torsion, nine healthy volunteers underwent MRI tagging at rest, after atropine injection, and after exercise.RESULTS Diabetic patients (hemoglobin Ale, 6.8 +/- 0.4%) had a higher resting HR (77.0 +/- 12.4 beats/min vs. 59.0 +/- 5.6 beats/min; p < 0.01), higher maximal torsion by 23% (3.5 +/- 0.9 degrees/cm vs. 2.7 +/- 0.4 degrees/cm; p < 0.01) and higher maximal systolic torsion rate (TR-s) by 25% (0.013 +/- 0.003 degrees/cm/s vs. 0.010 +/- 0.002 degrees/cm/s, p = 0.01). Torsion did not significantly change with chronotropic stimulation (p = 0.30).CONCLUSIONS In diabetics under tight glycemic control, we observed a surprising increase in torsion and TR-s unrelated to chronotropic influences of HR. We propose that increased torsion and TR-s could represent early predictive markers of the propensity to cardiac dysfunction in asymptomatic type I diabetics. Furthermore, these findings seem fundamental to the diabetic state itself and unaccounted for by other comorbidities.