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DOI: 10.1055/s-2007-973608
© Georg Thieme Verlag KG Stuttgart · New York
Verbesserung der Myokardfunktion durch verbesserte Stoffwechselkontrolle bei Typ-2-Diabetes
Augmentation of myocardial function by improved glycemic control in patients with type 2 diabetes mellitusPublication History
eingereicht: 8.1.2007
akzeptiert: 14.3.2007
Publication Date:
29 March 2007 (online)

Zusammenfassung
Hintergrund und Fragestellung: Bei Patienten mit Typ-2-Diabetes ist die myokardiale diastolische Dysfunktion ein häufiges und prognostisch ungünstiges Phänomen. In einer Kurz- und Langzeitstudie wurde die Hypothese getestet, dass die myokardiale Funktion durch bessere Blutzuckereinstellung kurz- und langfristig optimiert werden kann.
Methoden: In einer 3-wöchigen Kurz- und 52-wöchigen Langzeitstudie wurden bei 33 bzw. 50 Patienten durch intensivierte Insulintherapie niedrigere Blutzuckerwerte angestrebt. Vor und nach der Therapiemodifikation wurde die Myokardfunktion mittels gepulstem Gewebe-Doppler als systolische (Vs) und diastolische myokardiale Geschwindigkeit (Ve) bestimmt. Den 25 Patienten mit Therapieintensivierung in der Kurzzeitstudie standen als Kontrollgruppe 8 Patienten gegenüber und analog in der Langzeitstudie 39 vs. 11 Patienten.
Ergebnisse: In der Kurzzeitstudie reduzierte sich der Nüchternblutzucker unter intensivierter Insulintherapie um 69 ± 47 mg/dl (p < 0,01), assoziiert mit einem Anstieg der diastolischen Myokardgeschwindigkeit Ve von 8,0 ± 1,6 auf 8,8 ± 1,6 cm/s (p < 0,01) parallel zu Vs (6,2 ± 1,1 zu 6,6 ± 1,3 cm/s, p < 0,04). In der Kontrollgruppe blieben Blutzucker, Vs und Ve unverändert. In der Langzeitstudie sank der Blutzucker um 20 ± 43 mg/dl (p < 0,017) assoziiert mit einem Ve-Anstieg von 7,6 ±1,3 auf 8,3±1,7 cm/s (p < 0,002) parallel zum Trend in Vs (7,4 ± 0,9 zu 7,7 ± 0,9 cm/s, p < 0,07). In der Kontrollgruppe blieben Blutzucker und Myokardgeschwindigkeiten unverändert. Bei den gepoolten Daten korrelierte die Änderung von Ve signifikant mit der Veränderung des Blutzuckers (r = 0,49, p < 0,004 Kurzzeit- und r = 0,45; p < 0,002 Langzeitstudie).
Folgerungen: Die mit Gewebe-Doppler gemessene diastolische Myokardgeschwindigkeit als Maß für eine subklinisch reduzierte Myokardfunktion kann bei Typ-2-Diabetikern durch normnahe Stoffwechseleinstellung mittels intensivierter Insulintherapie verbessert werden.
Summary
Background: In patients with type 2 diabetes mellitus diastolic dysfunction is a frequent manifestation of myocardial disease with poor prognosis. The hypothesis that better glycemic control results in improved myocardial function was tested using tissue Doppler.
Methods: During a short-term (3 weeks) and a long-term (52 weeks) study, metabolic control and myocardial function were evaluated in 33 and 50 patients, respectively, with type 2 diabetes. Systolic (Vs) and diastolic (Ve) myocardial velocity were assessed by tissue Doppler. In the short-term study, antidiabetic therapy was intensified in 25 patients (Int3) and compared to those eight individuals with unchanged therapy (Con3), similarly to the long-term study with Int52 (n = 39) and Con52 (n = 11).
Results: In Int3, fasting serum glucose was reduced by 69±47 mg/dl (p < 0.01) compared to baseline and was associated with an increase of Ve from 8.0 ± 1.6 to 8.8 ± 1.6 cm/s (p < 0.01) and Vs from 6.2 ± 1.1 to 6.6 ± 1.3 cm/s, p < 0.04. In Con3, serum glucose and myocardial velocities were unchanged. In Int52, fasting serum glucose was reduced by 20 ± 43 mg/dl (p < 0.017) compared to baseline and was associated with an increase of Ve from 7.6 ± 1.3 to 8.3 ± 1.7 cm/s (p < 0.002) and a similar trend in Vs (p < 0.07). In Con52, serum glucose and myocardial velocities remained unchanged. Evaluating pooled data, the changes of diastolic myocardial velocity correlated significantly with the changes of serum glucose (r = 0.49, p < 0.004 short- and r = 0.45; p < 0.002 long-term study, respectively).
Conclusion: In patients with type 2 diabetes subclinical diastolic myocardial dysfunction, measured as diastolic myocardial velocity by tissue Doppler, improves with better glycemic control.
Schlüsselwörter
Diabetes mellitus - Gewebe Doppler - Myokardfunktion - diastolische Dysfunktion
Key words
diabetes mellitus - Doppler tissue imaging - myocardial function - diastolic dysfunction
Literatur
- 1
Appleton C P, Hatle L K.
The natural history of left ventricular filling abnormalities: assessment by two-dimensional
and Doppler echocardiography.
Echocardiography.
1992;
9
438-457
MissingFormLabel
- 2
Aurigemma G P, Silver K H, Priest M A, Gaasch W H.
Geometric changes allow normal ejection fraction despite depressed myocardial shortening
in hypertensive left ventricular hypertrophy.
J Am Coll Cardiol.
1995;
26
195-202
MissingFormLabel
- 3
Avgeropoulou C, Illmann A, Schumm-Draeger P M, Kallikazaros J, von Bibra H.
Assessment of arterio-ventriculo coupling in well controlled type 2 diabetes mellitus
and controls by tissue doppler and wave intensity approach.
Brit J Diabetes Vasc Dis.
2006;
6
271-278
MissingFormLabel
- 4
Bella J N, Palmieri V, Roman M J. et al .
Mitral ratio of peak early to late diastolic filling velocity as a predictor of mortality
in middle-aged and elderly adults. The Strong Heart Study.
Circulation.
2002;
105
1928-1933
MissingFormLabel
- 5
von Bibra H, Tuchnitz A, Klein A, Schneider-Eicke J, Schömig A, Schwaiger M.
Regional diastolic function by pulsed Doppler myocardial mapping for the detection
of left ventricular ischemia during pharmacologic stress testing - a comparison with
stress echocardiography and perfusion scintigraphy.
J Am Coll Cardiol.
2000;
36
444-452
MissingFormLabel
- 6
von Bibra H, Hansen A, Dounis V, Bystedt T, Malmberg K, Rydén L.
Insulin based improved metabolic control augments myocardial diastolic function and
perfusion in patients with type 2 diabetes mellitus.
Heart.
2004;
90
1483-1484
MissingFormLabel
- 7
von Bibra H, Thrainsdottir I S, Hansen A, Dounis V, Malmberg K, Rydén L.
Tissue Doppler imaging for the detection and quantitation of myocardial dysfunction
in patients with type 2 diabetes mellitus: a methodological study.
Diabetes Vasc Dis Res.
2005;
2
483-487
MissingFormLabel
- 8
Brownlee M.
Glycation products and the pathogenesis of diabetic complications.
Diabetes Care.
1992;
15
1835-1843
MissingFormLabel
- 9
Celentano A, Vaccaro O, Tammaro P, Galderisi M, Crivaro M, Oliviero M. et al .
Early abnormalities of cardiac function in non-insulin-dependent diabetes mellitus
and impaired glucose tolerance.
Am J Cardiol.
1995;
76
1173-1176
MissingFormLabel
- 10
Devereux R B, Roman M J, Liu J E. et al .
Congestive heart failure despite normal left ventricular systolic function in a population-based
sample: the strong heart study.
Am J Cardiol.
2000;
86
1090-1096
MissingFormLabel
- 11
Diamant M, Lamb H J, Groeneveld Y. et al .
Diastolic dysfunction is associated with altered myocardial metabolism in asymptomatic
normotensive patients with well-controlled type 2 diabetes mellitus.
J Am Coll Cardiol.
2003;
42
328-335
MissingFormLabel
- 12
Diamant M, Tushuizen M E.
The metabolic syndrome and endothelial dysfunction: common highway to type 2 diabetes
and CVD?.
Curr Diab Rep.
2006;
6
279-286
MissingFormLabel
- 13
Fang Z Y, Yuda S, Anderson V. et al .
Echocardiographic detection of early diabetic myocardial disease.
J Am Coll Cardiol.
2003;
41
611-617
MissingFormLabel
- 14
Fischer M, Baessler A, Hense H W. et al .
Prevalence of left ventricular diastolic dysfunction in the community. Results from
a Doppler echocardiographic-based survey of a population sample.
Eur Heart J.
2003;
24
320-328
MissingFormLabel
- 15
Fukuta H, Sane D C, Brucks S, Little W C.
Statin therapy may be associated with lower mortality in patients with diastolic heart
failure - a preliminary report.
Circulation.
2005;
112
357-363
MissingFormLabel
- 16
Gæde P, Vedel P, Larsen N, Jensen G VH, Parving H -H, Pedersen O.
Multifactorial intervention and cardiovascular disease in patients with type 2 diabetes.
N Engl J Med.
2003;
348
383-393
MissingFormLabel
- 17
Gaenzer H, Neumayr G, Marschang P. et al .
Effect of insulin therapy on endothelium-dependent dilatation in type 2 diabetes.
Am J Cardiol.
2002;
89
431-414
MissingFormLabel
- 18
Gilbert J C, Glantz S A.
Determinants of left ventricular filling and of the diastolic pressure-volume relation.
Circulation Research.
1989;
64
827-851
MissingFormLabel
- 19
Hansen A, Johansson B L, Wahren J, von Bibra H.
Beneficial effects of C-peptide on myocardial function in patients with type 1 diabetes.
Diabetes.
2002;
51
3077-3082
MissingFormLabel
- 20
Jain A, Avendano G, Dharamsey S. et al .
Left ventricular diastolic function in hypertension and role of plasma glucose and
insulin. Comparison with diabetic heart.
Circulation.
1996;
93
1396-1402
MissingFormLabel
- 21
Liu J E, Palmieri V, Roman M J. et al .
The impact of diabetes on left ventricular filling pattern in normotensive and hypertensive
adults: The strong heart study.
J Am Coll Cardiol.
2001;
37
1943-1949
MissingFormLabel
- 22
Poirier P, Bogaty P, Garneau C, Marois L, Dumesnil J G.
Diastolic dysfunction in normotensive men with well-controlled type 2 diabetes: Importance
of maneuvers in echocardiographic screening for preclinical diabetic cardiomyopathy.
Diabetes Care.
2001;
24
5-10
MissingFormLabel
- 23
Rask-Madsen C, Ihleman N, Krarup T. et al .
Insulin therapy improves insulin-stimulated endothelial function in patients with
type 2 diabetes and ischemic heart disease.
Diabetes.
2001;
50
2611-2618
MissingFormLabel
- 24
Saraiva R M, Duarte D M, Duarte M P. et al .
Tissue Doppler imaging identifies asymptomatic normotensive diabetics with diastolic
dysfunction and reduced exercise tolerance.
Echocardiography.
2005;
22
561-567
MissingFormLabel
- 25
Sohn D W, Chai I H, Lee D J. et al .
Assessment of mitral annulus velocity by Doppler tissue imaging in the evaluation
of left ventricular diastolic function.
J Am Coll Cardiol.
1997;
30
474-480
MissingFormLabel
- 26
Strauer B E, Motz W, Vogt M, Schwartzkopf B.
Impaired coronary flow reserve in NIDDM. A possible role for diabetic cardiomyopathy
in humans.
Diabetes.
1997;
46
(Suppl 2)
119-124
MissingFormLabel
- 27
Vinereanu D, Nicolaides E, Tweddel A. et al .
Subclinical left ventricular dysfunction in asymptomatic patients with type 2 diabetes
mellitus, related to serum lipids and glycated haemoglobin.
Clinical Science.
2003;
105
591-599
MissingFormLabel
- 28
Wiernsperger N F.
In defense of microvascular constriction in diabetes.
Clin Hemorheol Microcirc.
2001;
25
55-62
MissingFormLabel
- 29
Williams S B, Goldfine A B, Timimi F K, Ting H H, Roddy M A, Creafer M A.
Acute hyperglycemia attenuates endothelium-dependent vasodilatation in humans.
Circulation.
1998;
97
1695-1701
MissingFormLabel
Prof. Dr. Helene von Bibra
Abt. für Endokrinologie, Diabetologie und Angiologie, Städt. Klinikum GmbH, München-Bogenhausen
Englschalkingerstraße 77
81925 München
Phone: 0049/89/92702118
Fax: 0049/89/92702116
Email: von-Bibra@extern.lrz-muenchen.de