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Prediyabetik Hastalarda Sol Ventrikül Diyastolik Fonksiyonların ve Miyokard Performans İndeksinin Değerlendirilmesi

Year 2018, Yıl: 2018 Sayı: 1, 6 - 12, 01.04.2018
https://doi.org/10.5505/kjms.2018.37233

Abstract

Amaç: Kalp yetmezliği (KY), fonksiyonel kapasite ve hayat kalitesinin azalması, morbidite ve mortalitenin artışı ile karakterize progresif, kronik bir sendromdur. Korunmuş ejeksiyon fraksiyonlu (EF) kalp yetmezliği, KY olgularının yaklaşık yarısını temsil eder. Diyabetes mellitus (DM), KY ile yakından ilişkilidir ve DM hastalarında KY, iki-sekiz kat daha sıktır. Prediyabet, diyabetten önceki aşama olup, bozulmuş glukoz toleransı (BGT), bozulmuş açlık glukozu (BAG) veya her ikisinin varlığı olarak tanımlanmıştır. DM’nin, korunmuş EF’li kalp yetmezliği ve diyastolik disfonksiyonla ilişkisi ortaya konmuşsa da, prediyabetik evrenin diyastolik disfonksiyonla ilişkisi net değildir. Bu çalışma prediyabet ile diyastolik disfonksiyon arasındaki ilişkiyi ortaya koymayı amaçlamaktadır. 
Materyal ve Metot: Bu çalışma tek merkezli, prospektif, kesitsel bir çalışmadır. Çalışmaya, başvuru sırasında 75 gr glukoz ile yapılan oral glukoz tolerans testi (OGTT) ile normal, yeni diyabet veya prediyabet tanısı konulan 110 hasta alındı. Hastaların sistolik, diyastolik ve diğer kardiyak parametleri konvansiyonel ekokardiyografi ve doku Doppler ekokardiyografi ile değerlendirildi. Kontrol, prediyabet ve diyabet grupları, mitral kapak akım hızları ve doku Doppler bulguları ile diyastolik fonksiyonlar açısından karşılaştırıldı. 
Bulgular: Prediyabetiklerde, Mitral E/A oranı (kontrol: 1,10±0,26; prediyabet: 0,90±0,16; diyabet: 0,93±0,24; p=0,001), ortalama doku Doppler Em/Am oranı (kontrol: 1,13±0,33; prediyabet: 0,94±0,33; diyabet: 0,92±0,26; p=0,001), diyabetiklerde olduğu gibi azalmış olarak izlendi. Ayrı-ca deselerasyon zamanı, izovolumik relaksasyon zamanı, ve miyokardiyal performans indeksi prediyabetiklerde de diyabetiklerde olduğu gibi yüksek izlendi. Ayrıca bu çalışmada açlık kan şekeri ve OGTT ikinci saat kan şekeri ile mitral akım E/A oranı ve Doppler global Em/Am oranı arasında korelasyon saptandı. 
Sonuç: Diyastolik disfonksiyon indekslerini ve MPI’yı diyabetik hastalarla ve kontrol grubu ile karşılaştı-ran bu çalışmada, prediyabetik hastalarda, diyastolik disfonksiyon olduğu tespit edildi. Bu çalış-ma, diyabet komplikasyonlarının bu glukoz seviyelerinde dahi başladığını ve diyastolik disfonksi-yonun kan şeker seviyeleri korele olduğunu ortaya koymuştur.

References

  • 1. Schocken DD, Benjamin EJ, Fonarow GC, Krumholz HM, Levy D, Mensah GA, Narula J, et al. Prevention of heart failure: a scientific statement from the American Heart Association Councils on Epidemiology and Prevention, Clinical Cardiology, Cardiovascular Nursing, and High Blood Pressure Research; Quality of Care and Outcomes Research Interdisciplinary Working Group; and Functional Genomics and Translational Biology Interdisciplinary Working Group. Circulation 2008;117:2544–65.
  • 2. Borlaug BA, Nishimura RA, Sorajja P, Lam CS, Redfield MM. Exercise hemodynamics enhance diagnosis of early heart failure with preserved ejection fraction. Circ Heart Fail 2010;3:588– 95.
  • 3. Bhatia RS, Tu JV, Lee DS, Austin PC, Fang J, Haouzi A, et al. Outcome of heart failure with preserved ejection fraction in a population-based study. N Engl J Med 2006;355:260–9.
  • 4. Zhang P, Engelgau MM, Norris SL, Gregg EW, Narayan KM. Application of economic analysis to diabetes and diabetes care. Ann Intern Med 2004;140:972–7.
  • 5. Nichols GA, Koro CE, Kolatkar NS. The epidemiology of congestive heart failure in hyperglycemia below the threshold for diabetes: A critical review. Diab Met Synd: Clin Res Rew 2007:1;273–8.
  • 6. Stratton IM, Adler AI, Neil HA, Matthews DR, Manley SE, Cull CA, et al. Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study. BMJ 2000;321:405–12.
  • 7. Nichols GA, Hillier TA, Brown JB. Progression From Newly Acquired Impaired Fasting Glusose to Type 2 Diabetes. Diab Care 2007;30:228–33.
  • 8. Lam CS. Diabetic cardiomyopathy: An expression of stage B heart failure with preserved ejection fraction. Diab Vasc Dis Res 2015;12:234–8.
  • 9. American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diab Care 2010;33:62–9.
  • 10. Tei C, Ling LH, Hodge DO, Bailey KR, Oh JK, Rodeheffer RJ, et al. New index of combined systolic and diastolic myocardial performance: a simple and reproducible measure of cardiac function a study in normals and dilated cardiomyopathy. J Cardiol 1995;26:357–66.
  • 11. Hunt SA, Abraham WT, Chin MH, Feldman AM, Francis GS, Ganiats TG, et al 2009 focused update incorporated into the ACC/AHA 2005 Guidelines for the Diagnosis and Management of Heart Failure in Adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the International Society for Heart and Lung Transplantation. Circulation 2009;119: e391–479.
  • 12. Redfield MM. Heart failure with normal ejection fraction In: Libby P, Bonow RO, Mann DL, Zipes DP, Braunwald E, editors. Braunwald’s Heart Disease 8th ed. Saunders Elsevier; 2008:641–57.
  • 13. De Vegt F, Dekker JM, Jager A, Hienkens E, Kostense PJ, Stehouwer CD et al. Relation of impaired fasting and postload glucose with incident type2 diabetes in a Dutch population: The Hoorn Study. JAMA 2001;285:2109–13.
  • 14. American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diab Care 2008;31:55–60.
  • 15. Garber AJ, Handelsman Y, Einhorn D, Bergman DA, Bloomgarden ZT, Fonseca V, et al. Diagnosis and management of prediabetes in the continuum of hyperglycemia: when do the risks of diabetes begin? A consensus statement from the American College of Endocrinology and the American Association of Clinical Endocrinologists. Endocr Pract 2008;14:933–46.
  • 16. Tei C, Nishimura RA, Seward JB, Tajik AJ. Noninvasive Doppler-derived myocardial performance index: Correlation with simultaneous measurements of cardiac catheterization measurements. J Am Soc Echocardiogr 1997;10:169–78.
  • 17. Lacorte JC, Cabreriza SE, Rabkin DG, Printz BF, Coku L, Weinberg A, et al. Correlation of the Tei index with invasive measurements of ventricular function in a porcine model. J Am Soc Echocardiogr 2003;16:442–7.
  • 18. Kim H, Yoon HJ, Park HS, Cho YK, Nam CW, Hur SH, et al. Usefulness of tissue Doppler imaging-myocardial performance index in the evaluation of diastolic dysfunction and heart failure with preserved ejection fraction. Clin Cardiol 2011;34:494–9.
  • 19. Karvounis HI, Papadopoulos CE, Zaglavara TA, Nouskas IG, Gemitzis KD, Parharidis GE, et al. Evidence of left ventricular dysfunction in asymptomatic elderly patients with non-insulindependent diabetes mellitus. Angiol 2004;55:549–55.
  • 20. Masoudi FA, Inzucchi SE. Diabetes mellitus and heart failure: Epidemiology, mechanisms, and pharmacotheraph. Am J Cardiol 2007;99:113–32.

Assessment of Left Ventricular Diastolic Functions and Myocardial Performance Index in Patients with Prediabetes

Year 2018, Yıl: 2018 Sayı: 1, 6 - 12, 01.04.2018
https://doi.org/10.5505/kjms.2018.37233

Abstract

Aim: Heart failure (HF) is a progressive chronic syndrome characterized by a decreased in functional capacity and quality of life, and an increased in morbidity and mortality. Prediabetes is the first phase of DM and defined as presence of impaired glucose tolerance (IGT), impaired fasting glucose (IFG) or both. Although the association between DM and diastolic dysfunction has been established previously, the association between newly diagnosed prediabetes and diastolic functions is unclear. This study aims to reveal the relationship between prediabetes and diastolic dys-function. 
Material and Method: The present study is a single-center, prospective, cross-sectional study. 110 patients who were performed oral glucose tolerance test (OGTT) and newly diagnosed of prediabetes, diabetes or normal glucose metabolism (control) were included in the study. Systolic, diastolic and other cardiac parameters of patients were assessed by conventional echocardiography and tissue Doppler imaging. Control, prediabetes and diabetes groups were compared via mitral valve flow velocities and tissue Doppler findings, in terms of diastolic functions. 
Results: Mean mitral valve E/A (control: 1.10±0.26; prediabetes: 0.90±0.16; and diabetes: 0.93±0.24; p=0.001) and global tissue Doppler Em/Am ratios (control: 1.13±0.33; prediabet: 0.94±0.33; dia-betes: 0.92±0.26; p=0.001) were found to be decreased in prediabetic group, as similar to diabetic patients. Additionally deceleration times, isovolumic relaxation times and myocardial perfor-mance index were found to be significantly increased in prediabetic and diabetic groups when compared to control group. In addition a correlation between fasting blood glucose and OGTT 2nd hr blood glucose and mitral flow E/A and Doppler global Em/Am ratios was observed. 
Conclusion: In this study comparing diastolic dysfunction indices and MPI with diabetic patients and control group, it was determined that diastolic dysfunction was present in prediabetic patients. This study found that diabetic complications even started at these glucose levels and that diastolic dysfunction correlated with blood glucose levels.

References

  • 1. Schocken DD, Benjamin EJ, Fonarow GC, Krumholz HM, Levy D, Mensah GA, Narula J, et al. Prevention of heart failure: a scientific statement from the American Heart Association Councils on Epidemiology and Prevention, Clinical Cardiology, Cardiovascular Nursing, and High Blood Pressure Research; Quality of Care and Outcomes Research Interdisciplinary Working Group; and Functional Genomics and Translational Biology Interdisciplinary Working Group. Circulation 2008;117:2544–65.
  • 2. Borlaug BA, Nishimura RA, Sorajja P, Lam CS, Redfield MM. Exercise hemodynamics enhance diagnosis of early heart failure with preserved ejection fraction. Circ Heart Fail 2010;3:588– 95.
  • 3. Bhatia RS, Tu JV, Lee DS, Austin PC, Fang J, Haouzi A, et al. Outcome of heart failure with preserved ejection fraction in a population-based study. N Engl J Med 2006;355:260–9.
  • 4. Zhang P, Engelgau MM, Norris SL, Gregg EW, Narayan KM. Application of economic analysis to diabetes and diabetes care. Ann Intern Med 2004;140:972–7.
  • 5. Nichols GA, Koro CE, Kolatkar NS. The epidemiology of congestive heart failure in hyperglycemia below the threshold for diabetes: A critical review. Diab Met Synd: Clin Res Rew 2007:1;273–8.
  • 6. Stratton IM, Adler AI, Neil HA, Matthews DR, Manley SE, Cull CA, et al. Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study. BMJ 2000;321:405–12.
  • 7. Nichols GA, Hillier TA, Brown JB. Progression From Newly Acquired Impaired Fasting Glusose to Type 2 Diabetes. Diab Care 2007;30:228–33.
  • 8. Lam CS. Diabetic cardiomyopathy: An expression of stage B heart failure with preserved ejection fraction. Diab Vasc Dis Res 2015;12:234–8.
  • 9. American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diab Care 2010;33:62–9.
  • 10. Tei C, Ling LH, Hodge DO, Bailey KR, Oh JK, Rodeheffer RJ, et al. New index of combined systolic and diastolic myocardial performance: a simple and reproducible measure of cardiac function a study in normals and dilated cardiomyopathy. J Cardiol 1995;26:357–66.
  • 11. Hunt SA, Abraham WT, Chin MH, Feldman AM, Francis GS, Ganiats TG, et al 2009 focused update incorporated into the ACC/AHA 2005 Guidelines for the Diagnosis and Management of Heart Failure in Adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the International Society for Heart and Lung Transplantation. Circulation 2009;119: e391–479.
  • 12. Redfield MM. Heart failure with normal ejection fraction In: Libby P, Bonow RO, Mann DL, Zipes DP, Braunwald E, editors. Braunwald’s Heart Disease 8th ed. Saunders Elsevier; 2008:641–57.
  • 13. De Vegt F, Dekker JM, Jager A, Hienkens E, Kostense PJ, Stehouwer CD et al. Relation of impaired fasting and postload glucose with incident type2 diabetes in a Dutch population: The Hoorn Study. JAMA 2001;285:2109–13.
  • 14. American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diab Care 2008;31:55–60.
  • 15. Garber AJ, Handelsman Y, Einhorn D, Bergman DA, Bloomgarden ZT, Fonseca V, et al. Diagnosis and management of prediabetes in the continuum of hyperglycemia: when do the risks of diabetes begin? A consensus statement from the American College of Endocrinology and the American Association of Clinical Endocrinologists. Endocr Pract 2008;14:933–46.
  • 16. Tei C, Nishimura RA, Seward JB, Tajik AJ. Noninvasive Doppler-derived myocardial performance index: Correlation with simultaneous measurements of cardiac catheterization measurements. J Am Soc Echocardiogr 1997;10:169–78.
  • 17. Lacorte JC, Cabreriza SE, Rabkin DG, Printz BF, Coku L, Weinberg A, et al. Correlation of the Tei index with invasive measurements of ventricular function in a porcine model. J Am Soc Echocardiogr 2003;16:442–7.
  • 18. Kim H, Yoon HJ, Park HS, Cho YK, Nam CW, Hur SH, et al. Usefulness of tissue Doppler imaging-myocardial performance index in the evaluation of diastolic dysfunction and heart failure with preserved ejection fraction. Clin Cardiol 2011;34:494–9.
  • 19. Karvounis HI, Papadopoulos CE, Zaglavara TA, Nouskas IG, Gemitzis KD, Parharidis GE, et al. Evidence of left ventricular dysfunction in asymptomatic elderly patients with non-insulindependent diabetes mellitus. Angiol 2004;55:549–55.
  • 20. Masoudi FA, Inzucchi SE. Diabetes mellitus and heart failure: Epidemiology, mechanisms, and pharmacotheraph. Am J Cardiol 2007;99:113–32.
There are 20 citations in total.

Details

Primary Language Turkish
Subjects Clinical Sciences
Journal Section Research Article
Authors

İbrahim Rencüzoğulları

Mehmet Necdet Akkuş This is me

Publication Date April 1, 2018
Published in Issue Year 2018 Yıl: 2018 Sayı: 1

Cite

APA Rencüzoğulları, İ., & Akkuş, M. N. (2018). Prediyabetik Hastalarda Sol Ventrikül Diyastolik Fonksiyonların ve Miyokard Performans İndeksinin Değerlendirilmesi. Kafkas Journal of Medical Sciences, 8(1), 6-12. https://doi.org/10.5505/kjms.2018.37233
AMA Rencüzoğulları İ, Akkuş MN. Prediyabetik Hastalarda Sol Ventrikül Diyastolik Fonksiyonların ve Miyokard Performans İndeksinin Değerlendirilmesi. KAFKAS TIP BİL DERG. April 2018;8(1):6-12. doi:10.5505/kjms.2018.37233
Chicago Rencüzoğulları, İbrahim, and Mehmet Necdet Akkuş. “Prediyabetik Hastalarda Sol Ventrikül Diyastolik Fonksiyonların Ve Miyokard Performans İndeksinin Değerlendirilmesi”. Kafkas Journal of Medical Sciences 8, no. 1 (April 2018): 6-12. https://doi.org/10.5505/kjms.2018.37233.
EndNote Rencüzoğulları İ, Akkuş MN (April 1, 2018) Prediyabetik Hastalarda Sol Ventrikül Diyastolik Fonksiyonların ve Miyokard Performans İndeksinin Değerlendirilmesi. Kafkas Journal of Medical Sciences 8 1 6–12.
IEEE İ. Rencüzoğulları and M. N. Akkuş, “Prediyabetik Hastalarda Sol Ventrikül Diyastolik Fonksiyonların ve Miyokard Performans İndeksinin Değerlendirilmesi”, KAFKAS TIP BİL DERG, vol. 8, no. 1, pp. 6–12, 2018, doi: 10.5505/kjms.2018.37233.
ISNAD Rencüzoğulları, İbrahim - Akkuş, Mehmet Necdet. “Prediyabetik Hastalarda Sol Ventrikül Diyastolik Fonksiyonların Ve Miyokard Performans İndeksinin Değerlendirilmesi”. Kafkas Journal of Medical Sciences 8/1 (April 2018), 6-12. https://doi.org/10.5505/kjms.2018.37233.
JAMA Rencüzoğulları İ, Akkuş MN. Prediyabetik Hastalarda Sol Ventrikül Diyastolik Fonksiyonların ve Miyokard Performans İndeksinin Değerlendirilmesi. KAFKAS TIP BİL DERG. 2018;8:6–12.
MLA Rencüzoğulları, İbrahim and Mehmet Necdet Akkuş. “Prediyabetik Hastalarda Sol Ventrikül Diyastolik Fonksiyonların Ve Miyokard Performans İndeksinin Değerlendirilmesi”. Kafkas Journal of Medical Sciences, vol. 8, no. 1, 2018, pp. 6-12, doi:10.5505/kjms.2018.37233.
Vancouver Rencüzoğulları İ, Akkuş MN. Prediyabetik Hastalarda Sol Ventrikül Diyastolik Fonksiyonların ve Miyokard Performans İndeksinin Değerlendirilmesi. KAFKAS TIP BİL DERG. 2018;8(1):6-12.