Background

Discrepancies are present in the literature on resting myocardial mechanics in patients with uncomplicated type 2 diabetes mellitus (T2DM). Data are noticeably sparse regarding circumferential function and torsional mechanics. Resting deformation imaging may not be sensitive enough to detect subtle dysfunctions. The aim of this study was thus to comprehensively evaluate myocardial mechanics in patients with T2DM at rest and to investigate whether dobutamine stress echocardiography could unmask functional alterations that would remain otherwise subtle at rest.

Methods

Forty-four patients with T2DM and 35 healthy control subjects of similar age and sex were prospectively recruited. After conventional echocardiography, myocardial mechanics was evaluated at rest and during low-dose dobutamine stress echocardiography (target heart rate, 110 beats/min).

Results

Patients with T2DM presented with altered global diastolic function but preserved systolic function. Deformation imaging indexes were similar between groups at rest, but significant differences were noticed under dobutamine infusion for longitudinal strain (−21.2 ± 2.4% vs −24.2 ± 2.5%, P < .001), circumferential strain (apex, −32.3 ± 5.3% vs −36.3 ± 5.3%, P = .002; papillary muscle, −25.6 ± 3.2% vs −28.0 ± 3.6%, P = .001; base, −23.2 ± 3.6% vs −25.3 ± 3.8%, P = .03), apical (11.2 ± 4.4° vs 14.1 ± 6.3°, P = .020) and basal (−12.2 ± 3.3° vs −14.3 ± 3.9°, P = .021) rotation, and twist (21.9 ± 5.9° vs 26.8 ± 8.3°, P = .007). Multivariate analysis identified epicardial fat, dyslipidemia, and fasting glycaemia as significant contributors to the changes from rest to dobutamine.

Conclusions

These findings demonstrate the usefulness of dobutamine stress echocardiography in establishing impairments in myocardial mechanics in patients with uncomplicated T2DM. Systemic metabolic disturbances and epicardial fat act as the main contributors to the blunted response to dobutamine stress in these patients.

中文翻译：

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多巴酚丁胺应力超声心动图揭示无症状2型糖尿病无症状患者早期左心室功能障碍：全面的二维斑点跟踪成像研究。

背景

单纯性2型糖尿病（T2DM）患者静息心肌力学的文献存在差异。关于圆周功能和扭转力学的数据非常稀少。静止变形成像可能不够灵敏，无法检测到细微的功能障碍。因此，本研究的目的是全面评估静止期T2DM患者的心肌力学，并调查多巴酚丁胺负荷超声心动图检查是否能掩盖静止时仍会微妙的功能改变。

方法

前瞻性招募了44名T2DM患者和35名年龄和性别相似的健康对照者。在常规超声心动图检查之后，评估了静息状态和低剂量多巴酚丁胺负荷超声心动图检查的心肌力学（目标心率，110次/分钟）。

结果

T2DM患者表现出整体舒张功能改变，但保留了收缩功能。休息时两组之间的变形成像指标相似，但是在多巴酚丁胺输注下，纵向应变（−21.2±2.4％vs -24.2±2.5％，P  <.001），圆周应变（顶点，−32.3±5.3％）存在显着差异vs --36.3±5.3％，P  = .002;乳头肌，-25.6±3.2％vs -28.0±3.6％，P  = .001;基础，-23.2±3.6％vs -25.3±3.8％，P  = .03 ），根尖 旋转（11.2±4.4°vs 14.1±6.3°，P  = .020）和基础旋转（-12.2±3.3°vs −14.3±3.9°，P = .021）和扭曲（21.9±5.9°vs 26.8） ±8.3°，P = .007）。多变量分析确定心外膜脂肪，血脂异常和空腹血糖是从休息到多巴酚丁胺变化的重要因素。

结论

这些发现证明了多巴酚丁胺应力超声心动图在建立单纯性T2DM患者心肌力学损伤中的作用。在这些患者中，全身性代谢紊乱和心外膜脂肪是导致多巴酚丁胺应激反应迟钝的主要因素。