Quantification of diastolic dysfunction via the age dependence of diastolic function - Impact of insulin resistance with and without type 2 diabetes

INTERNATIONAL JOURNAL OF CARDIOLOGY

卷:182

Article

von Bibra, H.¹  Paulus, W. J.²  Sutton, M. St. John³  Leclerque, C.¹  Schuster, T.⁴  Schumm-Draeger, P. -M.¹ 

[1] Stadt Klinikum Munchen GmbH, Klinikum Bogenhausen, Clin Endocrinol Diabet & Vasc Med, Munich, Germany

[2] Vrije Univ Amsterdam, Vrije Univ, Med Ctr Amsterdam, Inst Cardiovasc Res, Amsterdam, Netherlands

[3] Univ Penn, Dept Med, Cardiovasc Div, Philadelphia, PA 19104 USA

[4] Tech Univ Munich, Inst Stat & Epidemiol Med, D-80290 Munich, Germany

关键词: Diastolic dysfunction;    Tissue Doppler;    Insulin resistance;    Metabolic cardiomyopathy;    Type 2 diabetes;    Heart failure preserved ejection fraction;   

DOI  :  10.1016/j.ijcard.2014.12.005

来源: Elsevier

【 摘 要 】

Background: The alarming prevalence of heart failure with preserved ejection fraction requires quantification of diastolic dysfunction (DDF). Myocardial diastolic velocity E' implies that age is the most important determinant. We tested the hypothesis that age allows for quantification of DDF and assessment of the structural and metabolic determinants in patients with and without type 2 diabetes (D). Methods: This prospective, cross-sectional study assessed cardiovascular, metabolic and ultrasound data in 409 consecutive patients (Diabetes Center, Bogenhausen-Munich) between 20 and 90 years without known cardiac disease and either with (n=204) or without D but with common prevalence of cardiovascular risk factors, including a subgroup of healthy individuals (H, n=94). Results: In H, E' related to age as: E'(norm)=-0.163 * years + 19.69 (R-2=0.77, p<0.0001). According to this 1% reduction by annual physiologic aging, DDF was quantitated as E'-E'(norm). Compared to nondiabetics, D patients were older, had greater BMI, lower E', more cardiovascular risk and greater DDF. In nondiabetics, grading of DDF by E-E'(norm) correlated with grading by filling pressure E/E'. Determinants of DDF by multivariate analysis included pulse wave velocity, diastolic blood pressure and the triglyceride/HDL ratio (a marker of insulin resistance) in nondiabetics and in D the same risk factors in reverse sequence and heart rate. Neither left atrial size nor left ventricular mass had significant impact. Conclusions: The physiological impact of age on myocardial function consists of a 1% annual reduction in E' and enables precise quantification of diastolic dysfunction thereby unmasking the importance of metabolic risk for DDF. (C) 2014 The Authors. Published by Elsevier Ireland Ltd.

【 授权许可】

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