Relation of aerobic capacity, left ventricular diastolic function and autonomic heart balance in patients with type 2 diabetes mellitus

[V. D. Vukomanović]

99 listova

Medicina - Kardiologija / Medicine - Cardiology

Utvrditi razlike u aerobnom kapacitetu, dijastolnoj funkciji leve komore i autonomnom balansu srca kod pacijenata sa šećernom bolešću tipa 2 i kontrolnom grupom zdravih ispitanika. Istražiti povezanost aerobne sposobnosti, dijastolne funkcije leve komore i autonomne modulacije srca kod istih ispitanika. Metod: U studiju je uključeno 109 ispitanika (53 ispitanika sa šećernom bolešću tipa 2 i 56 zdravih ispitanika slične starosne dobi koji su sačinjavali kontrolnu grupu. Svim ispitanicima su urađene laboratorijske analize, ehokardiografski pregled, 24-časovni Holter EKG-a i kardiopulmomalni test fizičkim opterećenjem. Ehokardiografski pregled je podrazumevao merenja u 2 D i M modu i doplerska merenja u cilju procene dijastolne funkcije leve komore. Preko 24-časovnog Holter EKG-a monitorninga kod svih ispitanika je analizirana varijabilnost srčane frekvencije u vremenskom i frekventnom domenu. Svima je urađen kardiopulmonalni test fizičkim opterećenjem, izmerena najviša dostignuta potrošnja kiseonika (VO2 peak) i zabeležena srčana frekvencija u oporavku nakon prvog minuta (HRR1.minut). Rezultati: Prosečna vrednost SDNN kod ispitanika sa DM iznosi 122 ± 32 ms, dok je kod ispitanika kontrolne grupe 152 ± 34 ms, što je statistički značajna razlika (t=4,741; p<0,001). I ostali parametri vremenskog domena (SDANN, SDNN index, RMSSD i p50NN) su statistički značajno niži kod dijabetičara u odnosu na kontrolnu grupu. Snaga spektra u niskofrekventnom (LF) i visokofrekventnom domenu (HF) je značajno niža kod osoba sa dijebetesom tokom dana, tokom noći i tokom 24h. Odnos E/A je značajno niži kod dijabetičara (0,98 ± 0,3 vs.1,18 ± 0,33, p=0,002). Takođe brzina pokreta septalnog (e’sept) i lateralnog (e’lat) segmenta mitralnog prstena u ranoj dijastoli je značajno niža kod obolelih od dijabetesa (0,07 ± 0,02 vs. 0,09 ± 0,03, p<0,001; 0,09 ± 0,03 vs.0,12 ± 0,08, p<0,001, redom) što ukazuje na poremećenu dijastolnu funkciju kod dijabetičara. Vrednosti E/e’sept, E/e’lat, E/e’ prosečno su statistički značajno niže u dijabetičara u odnosu na kontrolnu grupu zdravih ispitanika...

Determine differences in aerobic capacity, left ventricular diastolic function, and autonomic heart balance in patients with type 2 diabetes mellitus and control group of healthy subjects. Investigate the correlation of aerobic ability, diastolic function of the left ventricle and autonomic heart modulation in the same subjects. Methods: The study included 109 respondents (53 subjects with type 2 diabetes and 56 healthy subjects of the same age group who consisted of a control group). All subjects were subjected to laboratory analyzes, echocardiography, 24-hour ECG Holter and cardiopulmonary exercise testing. Echocardiographic examination involved measurement in 2D and M mods and Doppler measurements in order to assess the diastolic function of the left ventricle. Over 24 hours of Holter ECG monitored for all subjects, the heart rate variability in the time domain and frequency domain was analyzed. Each cardiopulmonary exercise testing was performed, the highest peak oxygen consumption (VO2 peak) was measured, and the heart rate recorded in recovery after the first minute (HRR 1. minute). Results: The mean SDNN of the subjects with DM is 122 ± 32 ms, while the control group subjects 152 ± 34 ms, which is a statistically significant difference (t = 4,741; p <0,001). And other time domain parameters (SDANN, SDNN index, RMSSD and p50NN) are statistically significantly lower in diabetics than the control group. The power of the spectrum in the low frequency (LF) and high frequency domain (HF) is significantly lower in people with diabetes during the day, during the night and during the 24 hours. The E/A ratio is significantly lower in diabetics (0.98 ± 0.3 vs.1.18 ± 0.33, p = 0.002). Also, the rate of movement of the septal (e'sept) and lateral (e'lat) segment of the mitral ring in the early diastole is significantly lower in patients with diabetes (0.07 ± 0.02 vs. 0.09 ± 0.03, p <0.001; 0.09 ± 0.03 vs 0.12 ± 0.08, p <0.001, respectively) indicating a disorder diastolic function in diabetics...

dijabetes melitus tip 2, kardiopulmonalni test opterećenja, leva komora, varijabilnost srčane frekvence

type 2 diabetes mellitus, cardiopulmonary exercise testing, the left ventricle, heart rate variability

616.12-008:616.379-008.64(043.3)

Tekst