Diabetes mellitus and echocardiographic left ventricular function in free-living elderly men and women: The cardiovascular health study
Diabetes mellitus and echocardiographic left ventricular function in free-living elderly men and women: The cardiovascular health study
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DOI：
10.1016/s0002-8703(97)70245-x
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发表时间：
1997-01-01
影响因子：
4.8
通讯作者：
Ward, BJ
中科院分区：
文献类型：
--
作者：
Lee, M;Gardin, JM;Ward, BJ
本报告描述了心血管健康研究中5201名年龄大于或等于65岁的男性和女性的超声心动图测量的左心室质量和充盈（递瓣血流）速度与糖尿病、血压和流行心血管疾病之间的关系。糖尿病患者的室间隔和左后壁厚度大于非糖尿病患者，且随着糖尿病病程的延长呈现显著的线性趋势（两性室间隔厚度之和p = 0.025，后壁厚度p = 0.002）。在队列中，室间隔或左后壁壁厚的增加与流行的冠心病（CHD）无关。左心室质量增加与未报告冠心病的糖尿病患者和所有冠心病患者相关，无论糖耐量状况如何。在调整体重、血压、心率和流行的冠状动脉或脑血管疾病后，糖尿病（通过血糖水平、胰岛素使用、口服降糖药使用和基线检查前的糖尿病阳性病史来测量）仍然是男性和女性左心室质量增加的独立预测因子（糖尿病男性为174.2 gm vs正常男性为169.8 gm，糖尿病女性为138.2 gm vs正常女性为134.0 gm，两性合并p = 0.043）。随着糖尿病病程的延长，舒张早期和晚期的峰值血流速度均升高，但计算出的早期峰值血流速度与晚期血流速度之比（E/A比）在有糖尿病史的受试者和空腹血糖正常的受试者之间无显著差异（男女合并，p = 0.190）。血糖水平、胰岛素使用、口服降糖药使用和基线检查前的糖尿病阳性史是晚期透射峰流速及其综合Row-velocity曲线的重要独立预测因子，但不是早期峰值流速积分或E/ a比的重要独立预测因子。糖尿病与老年人左心室结构和功能异常有关。在调整体重、血压、心率和报告的冠状动脉或脑血管疾病后，这种关联仍然存在。
This report describes the relation among diabetes, blood pressure, and prevalent cardiovascular disease, and echocardiographically measured left ventricular mass and filling (transmitral valve flow) velocities in the Cardiovascular Health Study, a cohort of 5201 men and women greater than or equal to 65 years of age. Ventricular septal and left posterior wall thicknesses were greater in diabetic than in nondiabetic subjects, showing a significant linear trend (p = 0.025 for ventricular septal thickness in both sexes combined, p = 0.002 for posterior wall thickness) with increased duration of diabetes. Increased wall thickness of the ventricular septum or the left posterior wall was not associated with prevalent coronary heart disease (CHD) in the cohort. Increased left ventricular mass was associated with diabetic persons not reporting CHD and with all subjects with CHD regardless of glucose tolerance status. After adjusting for body weight, blood pressure, heart rate, and prevalent coronary or cerebrovascular disease, diabetes (as measured by glucose level, insulin use, oral hypoglycemic use, and a positive history of diabetes before baseline examination) remained an independent predictor of increased left ventricular mass among men and women (174.2 gm in diabetic men vs 169.8 gm in normal men, 138.2 gm in diabetic women vs 134.0 gm in normal women, p = 0.043 for both sexes combined). Both early and late diastolic transmitral peak Row velocities were higher with increased duration of diabetes, but the calculated ratio of the early peak flow velocity to the late velocity (E/A ratio) did not differ significantly between subjects with historical diabetes and those with normal fasting glucose (both genders combined, p = 0.190). Glucose level, insulin use, oral hypoglycemic use, and a positive history of diabetes before baseline examination were significant independent predictors of the late transmitral peak flow velocity and its integrated Row-velocity curve but not for the integral of the early peak Row velocity or the E/A ratio. Diabetes is associated with abnormal left ventricular structure and function in elderly persons. This association persists after adjustment for body weight, blood pressure, heart rate, and reported coronary or cerebrovascular disease.