三维斑点追踪技术评价2型糖尿病合并非酒精性脂肪性肝病患者左心室功能
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摘要
目的探讨三维斑点追踪(3D-STE)技术评估2型糖尿病(T2DM)合并非酒精性脂肪性肝病(NAFLD)患者左心室功能的可行性。方法对30例T2DM不合并NAFLD(A组)、32例T2DM合并轻度NAFLD(B组)及35例T2DM合并中重度NAFLD患者(C组)行3D-STE检查,检测常规参数,包括二尖瓣口舒张早期与晚期峰值血流速度比值(E/A)、舒张末期室间隔厚度(IVSTd)、左心室下侧壁厚度(PWTd)及舒张末期左心室内径(LVDd)、收缩末期左心室内径(LVDs),左心室功能参数包括收缩末期左心房容积(LAV)、左心室质量(LVM)、左心室舒张末期容积(LVEDV)、左心室收缩末期容积(LVESV)、左心室质量指数(LVMI)、左心室射血分数(LVEF),以及3D-STE应变参数左心室整体纵向应变(GLS)、整体面积应变(GAS)、整体径向应变(GRS)和整体圆周应变(GCS)。以Pearson线性相关分析3D-STE参数与糖化血红蛋白(HbA1c)、体质量指数(BMI)的相关性。结果 3组E/A、IVSTd、PWTd、LVDd、LVDs、LVMI、LVEF、LVEDV及LVESV差异均无统计学意义(P均>0.05),A、B组GRS、GCS、GLS、GAS均较C组增加(P均<0.05)。GLS、GRS、GCS、GAS与HbA1c均呈负相关(r=-0.540、-0.476、-0.489、-0.623,P=0.040、0.032、0.037、0.020),与BMI均无相关性(P均>0.05)。结论 3D-STE可用于评价T2DM合并NAFLD患者左心室功能。
Objective To evaluate the feasibility of three-dimensional speckle tracking echocardiography(3 D-STE) in evaluating left ventricular(LV) function in type 2 diabetes mellitus(T2 DM) patients with non-alcoholic fatty liver disease(NAFLD). Methods Totally 30 T2 DM patients without NAFLD(group A), 32 T2 DM patients with mild NAFLD(group B) and 35 T2 DM patients with moderate to severe NAFLD(group C) underwent 3 D-STE. Echocardiographic parameters were obtained, including conventional parameters of the ratio of transmitral peak early to late diastolic velocity(E/A), interventricular septum thickness diastolic(IVSTd), posterior wall thickness diastolic(PWTd), LV end-diastolic diameter(LVDd) and LV end-systolic diameter(LVDs), as well as LV function parameters including end-systolic left atrial volume(LAV), LV mass(LVM), LV end-diastolic volume(LVEDV), LV end-systolic volume(LVESV), LV mass index(LVMI) and LV ejection fraction(LVEF), also 3 D-STE parameters including global longitudinal strain(GLS), global area strain(GAS), global radial strain(GRS) and global circumferential strain(GCS). The correlation of 3 D-STE parameters and glycosylated hemoglobin(HbA1 c), body mass index(BMI) were analyzed with Pearson linear correlation analysis. Results There was no difference of E/A, IVSTd, PWTd, LVDd, LVDs, LVMI, LVEF, LVEDV nor LVESV among the 3 groups(all P>0.05), but patients in groups B and A had higher GCS, GRS, GLS and GAS than in group C(all P<0.05). The correlation analysis showed negative correlation between GLS, GRS, GCS, GAS and HbA1 c(r=-0.540,-0.476,-0.489,-0.623, P=0.040, 0.032, 0.037, 0.020), while there was no obvious correlation between 3 D-STE parameters and BMI(all P>0.05). Conclusion 3 D-STE can be used to assess LV function in T2 DM patients with NAFLD.
Objective To evaluate the feasibility of three-dimensional speckle tracking echocardiography(3 D-STE) in evaluating left ventricular(LV) function in type 2 diabetes mellitus(T2 DM) patients with non-alcoholic fatty liver disease(NAFLD). Methods Totally 30 T2 DM patients without NAFLD(group A), 32 T2 DM patients with mild NAFLD(group B) and 35 T2 DM patients with moderate to severe NAFLD(group C) underwent 3 D-STE. Echocardiographic parameters were obtained, including conventional parameters of the ratio of transmitral peak early to late diastolic velocity(E/A), interventricular septum thickness diastolic(IVSTd), posterior wall thickness diastolic(PWTd), LV end-diastolic diameter(LVDd) and LV end-systolic diameter(LVDs), as well as LV function parameters including end-systolic left atrial volume(LAV), LV mass(LVM), LV end-diastolic volume(LVEDV), LV end-systolic volume(LVESV), LV mass index(LVMI) and LV ejection fraction(LVEF), also 3 D-STE parameters including global longitudinal strain(GLS), global area strain(GAS), global radial strain(GRS) and global circumferential strain(GCS). The correlation of 3 D-STE parameters and glycosylated hemoglobin(HbA1 c), body mass index(BMI) were analyzed with Pearson linear correlation analysis. Results There was no difference of E/A, IVSTd, PWTd, LVDd, LVDs, LVMI, LVEF, LVEDV nor LVESV among the 3 groups(all P>0.05), but patients in groups B and A had higher GCS, GRS, GLS and GAS than in group C(all P<0.05). The correlation analysis showed negative correlation between GLS, GRS, GCS, GAS and HbA1 c(r=-0.540,-0.476,-0.489,-0.623, P=0.040, 0.032, 0.037, 0.020), while there was no obvious correlation between 3 D-STE parameters and BMI(all P>0.05). Conclusion 3 D-STE can be used to assess LV function in T2 DM patients with NAFLD.
引文
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[3] Zamirian M MD,Samiee E MD,Moaref A MD,et al.Assessment of subclinical myocardial changes in non-alcoholic fatty liver disease:A case-control study using speckle tracking echocardiography.Iran J Med Sci,2018,43(5):466-472.
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[5] 郭娟,郭瑞强,陈金玲,等.对比三维斑点追踪技术和二维斑点追踪技术评价正常人左心室心肌应变.中国医学影像技术,2013,29(12):1960-1964.
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[7] Nagueh SF,Smiseth OA,Appleton CP,et al.Recommendations for the evaluation of left ventricular diastolic function by echocardiography:An update from the American society of echocardiography and the European association of cardiovascular imaging.J Am Soc Echocardiogr,2016,29(4):277-314.
[8] Dai W,Ye L,Liu A,et al.Prevalence of nonalcoholic fatty liver disease in patients with type 2 diabetes mellitus:A meta-analysis.Medicine (Baltimore),2017,96(39):e8179.
[9] Ballestri S,Lonardo A,Bonapace S,et al.Risk of cardiovascular,cardiac and arrhythmic complications in patients with non-alcoholic fatty liver disease.World J Gastroenterol,2014,20(7):1724-1745.
[10] Munteanu MA,Mircea PA.From NAFLD to cardiovascular disease.Is it (still) the metabolic syndrome?Clujul Med,2014,87(2):80-86.
[11] Jung JY,Park SK,Ryoo JH,et al.Effect of non-alcoholic fatty liver disease on left ventricular diastolic function and geometry in the Korean general population.Hepatol Res,2017,47(6):522-532.
[12] Singh GK,Vitola BE,Holland MR,et al.Alterations in ventricular structure and function in obese adolescents with nonalcoholic fatty liver disease.J Pediatr,2013,162(6):1160-1168.
[13] Cassidy S,Hallsworth K,Thoma C,et al.Cardiac structure and function are altered in type 2 diabetes and non-alcoholic fatty liver disease and associate with glycemic control.Cardiovasc Diabetol,2015,14(1):23.
[14] Zhou Q,Shen J,Liu Y,et al.Assessment of left ventricular systolic function in patients with iron deficiency anemia by three-dimensional speckle-tracking echocardiography.Anatol J Cardiol,2017,18(3):194-199.
[15] Karabay CY,Kocabay G,Kalayci A,et al.Impaired left ventricular mechanics in non-alcoholic fatty liver disease.Eur J Gastroenterol Hepatol,2014,26(3):325-331.
[16] 许敏锐,周义红,强德仁,等.糖化血红蛋白与代谢综合征的相关性研究.中国糖尿病杂志,2015,23(4):327-330.
[17] Di Sessa A,Umano GR,Miraglia Del Giudice E,et al.From the liver to the heart:Cardiac dysfunction in obese children with non-alcoholic fatty liver disease.World J Hepatol,2017,9(2):69-73.
[18] Liu Z,Que S,Xu J,et al.Alanine aminotransferase-old biomarker and new concept:A review.Int J Med Sci,2014,11(9):925-935.
[2] Wójcik-Cichy K,Kolińska-Berkan E,Piekarska A.The influence of NAFLD on the risk of atherosclerosis and cardiovascular diseases.Clin Exp Hepatol,2018,4(1):1-6.
[3] Zamirian M MD,Samiee E MD,Moaref A MD,et al.Assessment of subclinical myocardial changes in non-alcoholic fatty liver disease:A case-control study using speckle tracking echocardiography.Iran J Med Sci,2018,43(5):466-472.
[4] Mantovani A,Pernigo M,Bergamini C,et al.Nonalcoholic fatty liver disease is independently associated with early left ventricular diastolic dysfunction in patients with type 2 diabetes.PLoS One,2015,10(8):e0135329.
[5] 郭娟,郭瑞强,陈金玲,等.对比三维斑点追踪技术和二维斑点追踪技术评价正常人左心室心肌应变.中国医学影像技术,2013,29(12):1960-1964.
[6] European association for the study of the liver (EASL),European association for the study of diabetes (EASD),European association for the study of obesity (EASO).EASL-EASD-EASO clinical practice guidelines for the management of non-alcoholic fatty liver disease.J Hepatol,2016,64(6):1388-1402.
[7] Nagueh SF,Smiseth OA,Appleton CP,et al.Recommendations for the evaluation of left ventricular diastolic function by echocardiography:An update from the American society of echocardiography and the European association of cardiovascular imaging.J Am Soc Echocardiogr,2016,29(4):277-314.
[8] Dai W,Ye L,Liu A,et al.Prevalence of nonalcoholic fatty liver disease in patients with type 2 diabetes mellitus:A meta-analysis.Medicine (Baltimore),2017,96(39):e8179.
[9] Ballestri S,Lonardo A,Bonapace S,et al.Risk of cardiovascular,cardiac and arrhythmic complications in patients with non-alcoholic fatty liver disease.World J Gastroenterol,2014,20(7):1724-1745.
[10] Munteanu MA,Mircea PA.From NAFLD to cardiovascular disease.Is it (still) the metabolic syndrome?Clujul Med,2014,87(2):80-86.
[11] Jung JY,Park SK,Ryoo JH,et al.Effect of non-alcoholic fatty liver disease on left ventricular diastolic function and geometry in the Korean general population.Hepatol Res,2017,47(6):522-532.
[12] Singh GK,Vitola BE,Holland MR,et al.Alterations in ventricular structure and function in obese adolescents with nonalcoholic fatty liver disease.J Pediatr,2013,162(6):1160-1168.
[13] Cassidy S,Hallsworth K,Thoma C,et al.Cardiac structure and function are altered in type 2 diabetes and non-alcoholic fatty liver disease and associate with glycemic control.Cardiovasc Diabetol,2015,14(1):23.
[14] Zhou Q,Shen J,Liu Y,et al.Assessment of left ventricular systolic function in patients with iron deficiency anemia by three-dimensional speckle-tracking echocardiography.Anatol J Cardiol,2017,18(3):194-199.
[15] Karabay CY,Kocabay G,Kalayci A,et al.Impaired left ventricular mechanics in non-alcoholic fatty liver disease.Eur J Gastroenterol Hepatol,2014,26(3):325-331.
[16] 许敏锐,周义红,强德仁,等.糖化血红蛋白与代谢综合征的相关性研究.中国糖尿病杂志,2015,23(4):327-330.
[17] Di Sessa A,Umano GR,Miraglia Del Giudice E,et al.From the liver to the heart:Cardiac dysfunction in obese children with non-alcoholic fatty liver disease.World J Hepatol,2017,9(2):69-73.
[18] Liu Z,Que S,Xu J,et al.Alanine aminotransferase-old biomarker and new concept:A review.Int J Med Sci,2014,11(9):925-935.