Association of Cardiac Autonomic Neuropathy With Subclinical Myocardial Dysfunction in Type 2 Diabetes
Association of Cardiac Autonomic Neuropathy With Subclinical Myocardial Dysfunction in Type 2 Diabetes
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DOI：
10.1016/j.jcmg.2010.09.014
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发表时间：
2010-12-01
影响因子：
14
通讯作者：
Marwick, Thomas H.
中科院分区：
文献类型：
--
作者：
Sacre, Julian W.;Franjic, Bennett;Marwick, Thomas H.
本研究的目的是研究除了LV神经支配和功能的局部相关性之外，整体心脏自主神经病变（CAN）和左心室（LV）功能障碍之间的独立相关性，2型糖尿病（T2 DM）患者CAN代表了非缺血性糖尿病心肌病病因学的一种潜在机制。对118例2型糖尿病患者进行了心率变异性、心脏反射试验和超声心动图左室功能评价。使用彩色组织多普勒在6个基底段和中段计算收缩期峰值和舒张早期峰值（Ern）组织速度，在静息和运动峰值时定义收缩期和舒张期功能。结果CAN患者除峰值心率、变时指数和运动能力较低外，静息心率、收缩压、平均血压、主动脉硬化、血红蛋白A、尿白蛋白/肌酐比值均较高。舒张功能（Em）与CAN相关，由总频谱功率（r = 0.42，p < 0.001）和心脏/纵隔比值（r = 0.41，p = 0.017）证明。CAN患者的静息舒张功能（Em）和静息和运动时的收缩功能（收缩期组织峰值速度）显著降低。此外，总频谱功率与Em相关，与年龄、高血压、代谢因素和LV功能障碍的其他相关因素无关（β = 0.20，p = 0.035）。指示局部去神经支配的相对区域示踪剂缺陷主要在前壁和侧壁中（p < 0.001）。与区域Em的相关性，独立于整体碘123-间碘苄胍摄取，仅在中前壁（β = 0.45，p = 0.01）和中侧壁（β = 0.34，p = 0.03）中确定。然而，区域去神经支配和收缩或舒张不同步性之间没有发现任何关联。结论2型糖尿病的舒张功能障碍与交感神经完整性和自主神经病变的临床标志物的区域标志物。（J Am科尔心脏病学杂志2010;3：1207-15）（C）美国心脏病学会基金会2010年
OBJECTIVES The purpose of this study was to investigate the independent association between global cardiac autonomic neuropathy (CAN) and left ventricular (LV) dysfunction in addition to regional associations of LV dysinnervation and function, in patients with type 2 diabetes mellitus (T2DM).BACKGROUND CAN represents a potential mechanism in the etiology of nonischemic diabetic cardiomyopathy.METHODS Clinical measures of CAN based on total spectral power of heart rate variability and cardiac reflex testing and echocardiographic assessment of LV function were performed in 118 patients with type 2 diabetes mellitus. Systolic and diastolic function were defined at rest and peak exercise using peak systolic and peak early diastolic (Ern) tissue velocities, calculated in 6 basal- and mid-segments using color tissue Doppler. Iodine 123-meta odobenzylguanidine imaging was performed in 33 patients to directly quantify global (heart/mediastinum ratio) and regional LV sympathetic integrity.RESULTS Patients with CAN demonstrated higher resting heart rate, systolic and mean blood pressures, aortic st ffness, hemoglobin A,, and urine albumin/creatinine ratio, in addition to lower peak heart rate, chronotropic index, and exercise capacity. Diastolic function (Em) was associated with CAN, evidenced by total spectral power (r = 0.42, p < 0.001) and heart/mediastinum ratio (r = 0.41, p = 0.017). Diastolic function (Em) at rest and systolic function (peak systolic tissue velocity) at rest and exercise were significantly reduced in patients with CAN. Furthermore, total spectral power was associated with Em independent of age, hypertension, metabolic factors, and other relevant contributors to LV dysfunction (beta = 0.20, p = 0.035). Relative regional tracer deficits indicative of local denervation were predominant in the anterior and lateral walls (p < 0.001). Associations with regional Em, independent of global iodine 123-metaiodobenzylguanidine uptake, were identified exclusively in mid-anterior (beta = 0.45, p = 0.01) and mid-lateral walls (beta = 0.34, p = 0.03). However, no association was found between regional denervation and systolic or diastolic dyssynchrony.CONCLUSIONS The diastolic dysfunction of type 2 diabetes mellitus shows associations with both regional markers of sympathetic integrity and clinical markers of autonomic neuropathy. (J Am Coll Cardiol Img 2010;3:1207-15) (C) 2010 by the American College of Cardiology Foundation