The microvascular effects of insulin resistance and diabetes on cardiac structure, function, and perfusion: a cardiovascular magnetic resonance study.
The microvascular effects of insulin resistance and diabetes on cardiac structure, function, and perfusion: a cardiovascular magnetic resonance study.
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DOI：
10.1093/ehjci/jeu142
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发表时间：
2014-12
期刊：
影响因子：
--
通讯作者：
Plein S
中科院分区：
文献类型：
--
作者：
Larghat AM;Swoboda PP;Biglands JD;Kearney MT;Greenwood JP;Plein S
2型糖尿病是心力衰竭发展的独立危险因素。为了更好地理解这种情况发生的机制，我们研究了糖尿病患者和非糖尿病患者的心脏结构、功能和灌注。根据美国糖尿病协会指南，65例有创冠状动脉造影无狭窄的患者（30%）分为糖尿病（19例）和非糖尿病（46例），并进一步分为糖尿病前期（30例）和对照组（16例）。每位患者均进行了全面的心血管磁共振评估。计算左室（LV）质量、相对壁质量（RWM）、拉格朗日周向应变、左室扭转、心肌灌注储备（MPR）。糖尿病患者左室质量高于非糖尿病患者（112.8±39.7比91.5±21.3 g, P = 0.01），糖尿病患者左室质量高于糖尿病前期患者（112.8±39.7比90.3±18.7 g, P = 0.02）。糖尿病组左室扭转角高于非糖尿病组（9.65±1.90°比8.59±1.91°，P = 0.047）， MPR低于非糖尿病组（2.10±0.76 mL/g/min比2.84±1.25 mL/g/min, P = 0.01）。MPR与舒张早期应变率（r = - 0.310, P = 0.01）、左室扭转率（r = - 0.306, P = 0.01）有显著相关性。在多变量线性回归分析中，非糖尿病患者腰臀比与RWM有显著相关，而体重指数与RWM无显著相关（Beta = 0.34, P = 0.02）。糖尿病患者左室质量增加，左室扭转，MPR降低。MPR降低和左室扭转增加之间存在显著关联，提示糖尿病微血管疾病和心功能障碍之间可能存在机制联系。
Type 2 diabetes mellitus is an independent risk factor for the development of heart failure. To better understand the mechanism by which this occurs, we investigated cardiac structure, function, and perfusion in patients with and without diabetes. Sixty-five patients with no stenosis >30% on invasive coronary angiography were categorized into diabetes (19) and non-diabetes (46) which was further categorized into prediabetes (30) and controls (16) according to the American Diabetes Association guidelines. Each patient underwent comprehensive cardiovascular magnetic resonance assessment. Left-ventricular (LV) mass, relative wall mass (RWM), Lagrangian circumferential strain, LV torsion, and myocardial perfusion reserve (MPR) were calculated. LV mass was higher in diabetics than non-diabetics (112.8 ± 39.7 vs. 91.5 ± 21.3 g, P = 0.01) and in diabetics than prediabetics (112.8 ± 39.7 vs. 90.3 ± 18.7 g, P = 0.02). LV torsion angle was higher in diabetics than non-diabetics (9.65 ± 1.90 vs. 8.59 ± 1.91°, P = 0.047), and MPR was lower in diabetics than non-diabetics (2.10 ± 0.76 vs. 2.84 ± 1.25 mL/g/min, P = 0.01). There was significant correlation between MPR and early diastolic strain rate (r = −0.310, P = 0.01) and LV torsion (r = −0.306, P = 0.01). In multivariable linear regression analysis, non-diabetics waist–hip ratio, but not body mass index, had a significant association with RWM (Beta = 0.34, P = 0.02). Patients with diabetes have increased LV mass, LV torsion, and decreased MPR. There is a significant association between decreased MPR and increased LV torsion suggesting a possible mechanistic link between microvascular disease and cardiac dysfunction in diabetes.
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