Identification of a definite diabetic cardiomyopathy in type 2 diabetes by comprehensive echocardiographic evaluation: A cross-sectional comparison with non-diabetic weight-matched controls

• Published in: Journal of diabetes Vol. 7; no. 6; pp. 779 - 790
• Main Authors: Ofstad, Anne Pernille, Urheim, Stig, Dalen, Håvard, Orvik, Elsa, Birkeland, Kåre I, Gullestad, Lars, W Fagerland, Morten, Johansen, Odd Erik, Aakhus, Svend
• Format: Journal Article
• Language: English
• Published: Australia Blackwell Publishing Ltd 01.11.2015
• Subjects: Aged; Body Mass Index; Case-Control Studies; Confounding Factors (Epidemiology); Cross-Sectional Studies; Diabetes Mellitus, Type 2 - complications; Diabetes Mellitus, Type 2 - diagnosis; Diabetic Cardiomyopathies - diagnostic imaging; Diabetic Cardiomyopathies - etiology; Diabetic Cardiomyopathies - physiopathology; diabetic cardiomyopathy; Diastole; echocardiography; Echocardiography, Doppler, Color; Female; Humans; Hypertrophy, Left Ventricular - diagnostic imaging; Hypertrophy, Left Ventricular - etiology; Hypertrophy, Left Ventricular - physiopathology; left ventricular dysfunction; Logistic Models; Male; Middle Aged; Multivariate Analysis; obesity; Obesity - complications; Obesity - diagnosis; Odds Ratio; Predictive Value of Tests; Risk Factors; Systole; type 2 diabetes mellitus; Ventricular Dysfunction, Left - diagnostic imaging; Ventricular Dysfunction, Left - etiology; Ventricular Dysfunction, Left - physiopathology; Ventricular Function, Left; Ventricular Pressure; 关键词：糖尿病性心肌病，超声心动图，左心室功能不全，肥胖，2型糖尿病; type 2 diabetes mellitus; left ventricular dysfunction; diabetic cardiomyopathy; obesity; echocardiography; 关键词：糖尿病性心肌病，超声心动图，左心室功能不全，肥胖，2型糖尿病
• ISSN: 1753-0393; 1753-0407; 1753-0407
• DOI: 10.1111/1753-0407.12239

Background Subclinical left ventricular (LV) dysfunction is prevalent in type 2 diabetes (T2DM). As obesity has been proposed as one causal factor in the disease process, this could bias the reported prevalences. We wanted to characterize echocardiographic LV dysfunction in obese T2DM subjects as compared to non‐diabetic obese controls. Methods One hundred patients with T2DM without clinical signs of heart failure (29% females, mean ± SD age 58.4 ± 10.5 years, body mass index (BMI) 30.1 ± 5.5 kg/m2, blood pressure (BP) 141 ± 18/83 ± 9 mmHg) and 100 non‐diabetic controls (29% females) matched for age (58.6 ± 10.5 years), BMI (29.8 ± 4.0 kg/m2) and systolic BP (140 ± 14 mmHg) underwent echocardiography and color tissue Doppler imaging (TDI). Diastolic function was evaluated with conventional Doppler recordings and early (e′) and late (a′) myocardial velocities. The ratio between early transmitral filling (E) and the corresponding myocardial tissue velocity (e′) served as an index of LV filling pressure. Results T2DM patients had more concentric hypertrophy with a relative wall thickness of 0.42 ± 0.07 vs controls 0.38 ± 0.07, P < 0.001. The T2DM group had signs of diastolic dysfunction with lower E/A ratio (0.91 ± 0.27 vs. 1.12 ± 0.38, P < 0.001), deceleration time (195 ± 49 vs 242 ± 72 ms, P < 0.001), e′ (5.7 ± 2.0 vs. 6.6 ± 1.8 cm/s, P = 0.001), and a′ (6.5 ± 2.0 vs. 7.6 ± 1.5 cm/s, P < 0.001) compared to the controls, and higher E/e′ (13.3 ± 4.7 vs. 11.1 ± 3.5, P < 0.001). Thus, there were indications of pseudo normalization and increased filling pressure in the T2DM group, whereas the controls had evidence for relaxation abnormalities without elevated filling pressure. Conclusion Compared to a non‐diabetic obese group, more advanced subclinical impairment of diastolic function was seen in T2DM. 摘要 背景： 亚临床左心室功能不全在2型糖尿病（T2DM）患者中普遍存在。虽然目前已经有人提出肥胖是疾病进展的一个致病因素，但是这与报告的患病率之间可能还有很大的差距。与非糖尿病的肥胖对照组相比，我们想在肥胖的T2DM受试者中归纳左心室功能不全的超声心动图特征。 方法： 对100名没有心脏衰竭临床体征的T2DM患者（29%为女性，年龄[平均数±SD]为58.4 ± 10.5岁，体重指数为30.1 ± 5.5 kg/m2，血压为141 ± 18/83 ± 9 mmHg）以及100名（29%为女性）年龄（58.6 ± 10.5岁）、体重指数（29.8 ± 4.0 kg/m2）与收缩期血压（140 ± 14 mmHg）都相匹配的非糖尿病对照者都进行了超声心动图与彩色组织多普勒成像（tissue Doppler imaging，TDI）检查。通过常规多普勒超声记录以及早期（e′）与晚期（a′）心肌速度来评估舒张期功能。将舒张早期充盈（E）与相应的心肌组织速度（e′）之间的比值作为左心室充盈压力指数。 结果： 与对照组（相对壁厚：0.38 ± 0.07）相比，T2DM患者的心肌更容易出现向心性肥厚，其相对壁厚为0.42 ± 0.07，P < 0.001。T2DM组具有心脏舒张功能不全的特征，他们的E/A比值（0.91 ± 0.27 vs 1.12 ± 0.38，P < 0.001）、减速时间（195 ± 49 vs 242 ± 72 ms，P < 0.001）、e′（5.7 ± 2.0 vs 6.6 ± 1.8 cm/s，P = 0.001）以及a′（6.5 ± 2.0 vs 7.6 ± 1.5 cm/s，P < 0.001）与对照组相比都降低了，而E/e′则升高了（13.3 ± 4.7 vs 11.1 ± 3.5，P < 0.001）。因此，在T2DM组中有假性正常化以及充盈压力增加的迹象，然而在对照组却有证据表明舒张功能异常且没有伴随着充盈压力增加。 结论： 与非糖尿病的肥胖组相比，在T2DM组中可以见到更多的舒张功能的晚期亚临床损害。