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Cardiovasc Diabetol:心肌梗死后的心肌瘢痕对糖尿病患者左心室变形的影响

2021-11-14 Nebula MedSci原创

2 型糖尿病 (T2DM) 是冠状动脉疾病和心肌梗死 (MI) 的主要危险因素

2 型糖尿病 (T2DM) 是冠状动脉疾病和心肌梗死 (MI) 的主要危险因素。糖尿病心肌病和心肌梗死瘢痕对 2 型糖尿病 患者心肌变形的相互作用尚不明确。

该研究旨在使用心脏磁共振 (CMR) 来评估既往心梗过的 2 型糖尿病患者的心肌变形情况,同时研究心肌瘢痕对左心室 (LV) 变形的影响。

总体上,共招募了202位 2 型糖尿病患者,其中46位有心肌梗死病史(T2DM[MI+]),另156位既往无心梗病史(T2DM[MI-]),还纳入了59位接受 CMR 扫描的正常对照个体。通过晚期钆增强评估心肌瘢痕。对比各组患者间的左心室功能和变形,包括左心室整体功能指数、左心室整体峰值应变 (PS)、峰值收缩应变率 (PSSR) 和峰值舒张应变率 (PDSR)。

左心室整体应变和增强区的测量

与其他组相比,T2DM(MI+) 组患者的左心室功能和左心室整体峰值应变、峰值收缩应变率和峰值舒张应变率均有所降低。在前壁梗死的 T2DM(MI+) 组中观察到左心室变形稍少 (p<0.017)。左心室总梗死范围和左心室梗死质量的增加与左心室全局峰值应变(径向、圆周和纵向;p<0.01)和左心室整体峰值收缩应变率(径向和圆周方向,p<0.02)降低有关。

左心室整体峰值应变率与左心室功能的相关性

多变量分析表明,NYHA 功能等级和左心室总梗死范围与左心室整体径向峰值应变(β值分别是-0.400和-0.446; p<0.01;R2=0.37)和圆周峰值应变(β值分别是0.339和0.530;p<0.01;R2=0.41)独立相关;左心室前壁梗死与左心室整体纵向峰值应变(β=0.398,p=0.006)独立相关。

综上,2 型糖尿病患者心肌梗死后的心肌瘢痕面积与左心室的整体峰值应变和峰值收缩应变率呈负相关。此外,不同的心肌梗死区域对左心室变形有不同的影响,应加强相关的临床评估。

原始出处:

Gao, Y., Xu, Hy., Guo, Yk. et al. Impact of myocardial scars on left ventricular deformation in type 2 diabetes mellitus after myocardial infarction by contrast-enhanced cardiac magnetic resonance. Cardiovasc Diabetol 20, 215 (2021). https://doi.org/10.1186/s12933-021-01407-2

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    2022-08-12 quxin068
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  5. 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  6. 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  7. 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  8. 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    2021-11-15 查查佳佳

    是极为不平静的一天。就是在这一

    0

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