Echocardiographic detection of early diabetic myocardial disease
Echocardiographic detection of early diabetic myocardial disease
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DOI：
10.1016/s0735-1097(02)02869-3
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发表时间：
2003-02-19
影响因子：
24
通讯作者：
Marwick, TH
中科院分区：
文献类型：
--
作者：
Fang, ZY;Yuda, S;Marwick, TH
我们试图确定在没有明显心脏病的糖尿病患者中是否可以检测到心肌收缩力和反射率的紊乱，以及这些变化是否独立于左心室肥大（LVH）并与之递增。但LVH在这一人群中很常见，糖尿病左室功能障碍与LVH的关系尚不清楚。单纯糖尿病组（DM组）48例，单纯LVH组（LVH组）45例，糖尿病合并LVH组（DH组）45例，正常对照组48例。对每例患者的心尖四腔、长轴和两腔视图中六个壁的峰值应变和应变率进行评估并取平均值。结果所有患者组（DM、DH、LVH）与对照组相比，收缩功能降低，表现为峰值应变（p < 0.001）和应变率（p = 0.005）降低。校准的113（代表心肌反射率）在每个患者组中均大于对照组（p < 0.05）。DH组的峰值应变和应变率显著低于单纯DM组（p < 0.03）或单纯LVH组（p = 0.01）。结论无明显心脏病的糖尿病患者存在收缩功能障碍和心肌反射率增加的证据。虽然这些变化与LVH引起的变化相似，但它们是独立的，并且是LVH效应的增量。(C)2003年由美国心脏病学会基金会。
OBJECTIVES We sought to determine whether disturbances of myocardial contractility and reflectivity could be detected in diabetic patients without overt heart disease and whether these changes were independent and incremental to left ventricular hypertrophy (LVH).BACKGROUND Left ventricular (LV) dysfunction is associated with diabetes mellitus, but LVH is common in this population and the relationship between diabetic LV dysfunction and LVH is unclear.METHODS We studied 186 patients with normal ejection fraction and no evidence of CAD: 48 with diabetes mellitus only (DM group), 45 with LVH only (LVH group), 45 with both diabetes and LVH (DH group), and 48 normal controls. Peak strain and strain rate of six walls in apical four-chamber, long-axis, and two-chamber views were evaluated and averaged for each patient. Calibrated integrated backscatter (113) was assessed by comparison of the septal or posterior wall with pericardial IB intensity.RESULTS All patient groups (DM, DH, LVH) showed reduced systolic function compared with controls, evidenced by lower peak strain (p < 0.001) and strain rate (p = 0.005). Calibrated 113, signifying myocardial reflectivity, was greater in each patient group than in controls (p < 0.05). Peak strain and strain rate were significantly lower in the DH group than in those in the DM alone (p < 0.03) or LVH alone (p = 0.01) groups.CONCLUSIONS Diabetic patients without overt heart disease demonstrate evidence of systolic dysfunction and increased myocardial reflectivity. Although these changes are similar to those caused by LVH, they are independent and incremental to the effects of LVH. (C) 2003 by the American College of Cardiology Foundation.