Changes in diastolic dysfunction in diabetes mellitus over time.
Changes in diastolic dysfunction in diabetes mellitus over time.
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DOI：
10.1016/j.amjcard.2009.01.358
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发表时间：
2009-05-15
影响因子：
2.8
通讯作者：
Chen, Horng H.
中科院分区：
文献类型：
--
作者：
From, Aaron M.;Scott, Christopher G.;Chen, Horng H.
已有多项研究证实糖尿病(DM)患者存在独立于冠心病或高血压的临床前左室(LV)舒张期功能障碍。我们研究的目的是确定由组织多普勒指数确定的左室舒张功能障碍是否随着糖尿病病程的延长而恶化，并将功能障碍的严重程度量化为糖尿病病程的函数。从1996年到2007年，所有无心衰的奥姆斯特德县，明尼苏达州的居民随后用组织多普勒超声心动图测量了舒张期功能。我们确定了一组经过验证的糖尿病患者，486名患者随后进行了组织多普勒超声心动图舒张期功能评估。经简单线性回归分析，E/e‘比值与糖尿病诊断至超声心动图的时间显著相关，在调整了年龄、性别、体重指数、既往冠心病、既往高血压和射血分数后，发病后每1年E/e’增加0.23(95%CI=0.16~0.30；P=0.007)。在调整了年龄、性别、体重指数、既往冠心病、既往高血压和射血分数(OR=1.91，95%CI=1.19-3.07；p=0.007)后，多变量Logistic回归模型显示，糖尿病病程4年与左室舒张功能不全(E/e‘和≥；15)独立相关。在验证的队列中有48例死亡(6例心源性死亡)。在多变量比例风险模型中，在调整了年龄、性别、冠心病、高血压、射血分数、左房容量和从DM到ECHO的时间后，E/E‘值可预测全因死亡率(Risk Ratio=1.11，95%CI=1.03~1.20；p=0.005)。综上所述，糖尿病患者≥病程为4年与显著的左室舒张功能不全相关。左室舒张功能不全可独立于高血压和冠状动脉疾病预测糖尿病患者的全因死亡率。
Several studies have demonstrated evidence for preclinical left ventricular (LV) diastolic dysfunction in patients with diabetes mellitus (DM) independent of coronary disease or hypertension. The objective of our study was to determine if LV diastolic dysfunction determined by tissue Doppler indices worsens with duration of DM and to quantify the severity of dysfunction as a function of DM duration. From 1996 to 2007, all Olmsted County, MN residents with DM free of heart failure who had a subsequent measurement of diastolic function using tissue Doppler echocardiography were identified. We identified a validated group of 486 patients with incident diabetes mellitus with a subsequent tissue Doppler echocardiographic assessment of diastolic function. There was a significant association between the E/e’ ratio and the time from diabetes diagnosis to echocardiogram using simple linear regression; for every 1 year after the onset of diabetes, the E/e’ increased by 0.23 (95% CI=0.16–0.30; p=0.007) after adjustment for age, gender, body mass index, prior coronary disease, prior hypertension and ejection fraction. A duration of diabetes ≥ 4 years was independently associated with LV diastolic dysfunction (E/e’>15) in multivariable logistic regression modeling after adjustment for age, gender, body mass index, prior coronary disease, prior hypertension and ejection fraction (OR=1.91, 95% CI=1.19–3.07; p=0.007). There were 48 deaths in the validated cohort (6 cardiac deaths). In multivariable proportional hazard modeling, the E/e’ ratio was predictive of all-cause mortality after adjustment for age, gender, coronary disease, hypertension, ejection fraction, left atrial volume and time from DM to echo (risk ratio= 1.11, 95% CI=1.03–1.20; p=0.005). In conclusion, a duration of DM of ≥ 4 years is correlated with significant LV diastolic dysfunction. LV diastolic dysfunction is predictive of all-cause mortality in patients with DM independent of hypertension and coronary disease.
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