Cardiovasc Diabetol:糖尿病+心衰患者的进行性右心室功能变化

2022-06-24 MedSci原创 MedSci原创

血糖水平和右心室功能的控制对合并糖尿病的慢性心衰患者的预后至关重要。

T.O.S.CA.注册处近期报道,存在慢性心力衰竭(CHF)和胰岛素轴受损(胰岛素抵抗[IR]或糖尿病[T2D])的患者的发病率和死亡率增加。但是,目前关于IR和T2D对心脏结构和功能、心肺功能表现及其在CHF中的纵向变化的相对影响的信息很少。

T.O.S.CA.注册处招募的患者,在基线和36个月平均随访过程中都进行了超声心动图和心肺运动测试。基于胰岛素受损状态,受试患者被分成三组:血糖正常且无IR(EU)、血糖正常但有IR(IR)和T2D。


左右心室结构和功能的纵向变化

与EU和IR相比,T2D与充盈压增加(T2D、EU和IR患者的E/e′比分别是15.9±8.9、12.0±6.5和14.5±8.1, p<0.01)和右心室(RV)- 动脉解偶联(RVAUC)更差(TAPSE/PASP比分别是0.52±0.2、0.6±0.3和0.6±0.3, p<0.05)相关。与此类似,研究人员还观察到T2D患者的耗氧量峰值也相比EU和IR患者的明显受损(VO2峰值分别是15.8±3.8 ml/Kg/min、18.4±4.3 ml/Kg/min和16.5±4.3 ml/Kg/min, p<0.003)。

纵向数据显示,T2D组的RVAUC、右心室大小和VO2峰值的恶化程度更明显(右心室大小增加13%,TAPSE/PAPS比降低21%、VO2峰值降低20%)。

总之,在T.O.S.CA.注册处研究中,与血糖正常的慢性心力衰竭患者相比,HF-T2D患者表现出更高的死亡和CV住院风险与进行性右心室功能障碍和运动障碍相关,提示了高血糖和右心室功能对心衰患者预后的重要性。

 

原始出处:

Salzano, A., D’Assante, R., Iacoviello, M. et al. Progressive right ventricular dysfunction and exercise impairment in patients with heart failure and diabetes mellitus: insights from the T.O.S.CA. Registry. Cardiovasc Diabetol 21, 108 (2022). https://doi.org/10.1186/s12933-022-01543-3.

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    2022-10-17 docwu2019
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    2022-12-29 quxin068
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