Volume-time curve of cardiac magnetic resonance assessed left ventricular dysfunction in coronary artery disease patients with type 2 diabetes mellitus
Volume-time curve of cardiac magnetic resonance assessed left ventricular dysfunction in coronary artery disease patients with type 2 diabetes mellitus
复制标题
心脏磁共振容量-时间曲线评估2型糖尿病冠心病患者左心室功能障碍
DOI：
10.1186/s12872-017-0583-5
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发表时间：
2017-06-05
影响因子：
2.1
通讯作者：
Xie, Lin-jun
中科院分区：
文献类型：
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作者：
Xu, Hua-yan;Yang, Zhi-gang;Xie, Lin-jun
研究背景2型糖尿病（Type 2 diabetes mellitus，DM 2）可引起心外膜冠状动脉病变，同时也可引起左室心肌损害。DM 2组左室功能不全。本研究应用心脏磁共振容积-时间曲线（CMR）技术，比较了冠心病（CAD）合并2型糖尿病（DM 2）患者、非DM 2患者及正常对照组的左室功能。测量并比较两组患者左室舒张末期容积（EDV）、收缩末期容积（ESV）、每搏输出量（SV）、射血分数（EF）及形态学参数舒张末期内径（EDD）、收缩末期内径（ESD）。容量-时间曲线参数，包括峰值射血率（PER）、峰值射血时间（PET）、峰值充盈率（PFR）、ES的峰值充盈时间（PFT）、标准化为EDV的峰值射血率（PER/EDV）和标准化为EDV的峰值充盈率（PFR/EDV），结果与正常对照组和无DM 2的CAD组相比，DM 2的CAD组LVEF明显降低（p < 0.05）。糖尿病组LVEDD较正常组和非糖尿病组显著增大（p < 0.05）。更重要的是，左心室容积时间曲线的最低参数（即，糖尿病组PER、PFR、PER/EDV、PFR/EDV均显著高于对照组（P < 0.05）。在糖尿病CAD患者中，Logistic回归分析表明PET、PFT和PFR/EDV是左心室功能不全的独立预测因子（比值比[OR]分别为1.1208、1.0161和0.0139）。当阈值大于164.4 msec时，PET的敏感性和特异性分别为81.2%和90%;对于PFT，敏感性和特异性分别为87.5%和95.0%（标准>166.0 msec）。PFR/EDV（≤3.7EDV/s）的敏感性（87.5%）和特异性（100.0%）较高。
BackgroundType 2 diabetes mellitus (DM2) may induce epicardial coronary artery diseases and left ventricular myocardial damaging as well. Left ventricular dysfunction was found in DM2. In this research, we compared the left ventricular dysfunction of coronary artery disease (CAD) patients with and without type 2 diabetes mellitus as well as normal controls using the volume-time curve of cardiac magnetic resonance (CMR).MethodsSixty-one CAD patients (28 with DM2 and 33 without DM2) and 18 normal individuals were enrolled in this study. Left ventricular function parameters, including the end-diastolic and end-systolic volumes (EDV, ESV), stroke volume (SV) and ejection fraction (EF), and morphologic dimension parameters (end diastolic and systolic diameter (EDD and ESD), were measured and compared. Volume-time curve parameters, including the peak ejection rate (PER), peak ejection time (PET), peak filling rate (PFR), peak filling time from ES (PFT), peak ejection rate normalized to EDV (PER/EDV), and peak filling rate normalized to EDV (PFR/EDV), were derived automatically and compared.ResultsLVEF in the diabetic CAD group was markedly reduced when compared to the normal and CAD without DM2 groups (allp< 0.05). LVEDD of the diabetic CAD group was significantly enlarged compared to the normal and non-diabetic CAD groups (allp< 0.05). More importantly, the lowest parameters of the left ventricle volume time curve (i.e., PER, PFR, PER/EDV and PFR/EDV) were obtained in diabetic CAD patients (allp< 0.05). In diabetic CAD patients, logistic regression analysis indicated that PET, PFT and PFR/EDV were independent predictors of left ventricular dysfunction (odds ratio [OR]: 1.1208, 1.0161, and 0.0139, respectively). The sensitivity and specificity of PET were 81.2 and 90%, respectively, when the threshold value was greater than 164.4 msec; for PFT, the sensitivity and specificity were 87.5 and 95.0%, respectively (criterion >166.0 msec). Higher sensitivity (87.5%) and specificity (100.0%) were obtained for PFR/EDV (criterion ≤3.7EDV/s).ConclusionsParameters that are derived from the volume-time curve on CMR, including PET, PFT and PFR/EDV, allow clinicians to predict left ventricular dysfunction in diabetic CAD subjects with a high degree of sensitivity and specificity.