Vol. 11, No 1, 2004 pp. 16 - 19
UC 616.379-008.64:616.127]:616-073 
DOPPLER TISSUE VELOCITY SAMPLING FOR THE EARLY DETECTION OF MYOCARDIAL DYSFUNCTION IN DIABETIC PATIENTS
Marina Ž. Deljanin Ilić, Stevan N. Ilić, Predrag Milosavljević
Institute for Prevention, Treatment and Rehabilitation of Cardiovascular Patients, Niška Banja, University of Niš
E-mail: marinadi@bankerinter.net
Summary. The aim of the study was to analyze the value of the Doppler tissue imaging (DTI) method in the early detection of myocardial dysfunction in diabetic patients.
Thirty-two patients with type 2 diabetes and twenty-five non-diabetic control subjects without clinical signs of coronary artery disease and with normal global left ventricular function by standard 2D echocardiography, were investigated with pulsed wave DTI at rest and after exercise stress echocardiography (ESE). Myocardial function was calculated as mean value from five basal left ventricular segments for the peak velocity at systole (Vs), early diastole (Ve), atrial contraction (Va) and ratio Ve/Va.
Compared to controls diabetic patients had a compromised Ve at rest (P<0.01). Their resting Va was higher (P<0.02), ratio Ve/Va lower (P<0.001) and Vs less (NS) than in the control group. After ESE in patients with diabetes Ve increased by 17.6%, Va by 11.8%, ratio Ve/Va by 6.6% and Vs by 14.6% compared to baseline values. In the control group changes in myocardial function induced by ESE were more pronounced: Ve increased by 34.3%, Va by 15.8%, ratio Ve/Va by 15.4% and Vs by 37.8%. Impaired response of myocardial function during ESE in diabetic patients resulted to more significant difference in Ve (P<0.001) and significant difference in Vs (P<0.001) between diabetic patients and controls after ESE.
In conclusion, patients with type 2 diabetes have early signs of predominant diastolic and also systolic myocardial dysfunction which are more expressed during ESE. Those signs can be identified by quantitative DTI before appearance of clinical signs of cardiovascular disease.
Key words: Diabetes mellitus, myocardial function, Doppler tissue imaging, stress echocardiography
TKIVNI DOPPLER U RANOJ DETEKCIJI MIOKARDNE DISFUNKCIJE
KOD BOLESNIKA S DIJABETESOM
Kratak sadržaj: Cilj studije bio je analiza značaja metode tkivnog Dopplera (DTI) u ranoj detekciji miokardne disfunkcije kod bolesnika s dijabetesom tipa 2.
Tridesetdva bolesnika s dijabetesom tip 2 i dvadesetpet osoba bez dijabetesa, bez kliničkih znakova za koronarnu bolest i sa normalnom globalnom funkcijom leve komore na standardnom 2D ehokardiogramu, ispitivano je primenom pulsnog tkivnog Dopplera (PW DTI) pre i posle stres ehokardiografskog testa fizičkim opterećenjem (ESE). Miokardna funkcija izračunata je kao srednja vrednost maksimalne miokardne brzine iz pet bazalnih segmenata leve komore u sistoli (Vs), ranoj dijastoli (Ve), tokom atrijalne kontrakcije (Va) i odnosa Ve/Va.
U poredjenju sa kontrolnom grupom bolesnici s dijabetesom, pre ESE, imali su manju vrednost Ve (P<0,01), veću vrednost Va (P<0,02), manji odnos Ve/Va (P<0,001) i manju vrednost Vs (NS). Posle ESE, u bolesnika s dijabetesom registrovano je povećanje Ve za 17,6%, Va za 11,8%, odnosa Ve/Va za 6,6% i Vs za 14,6% u odnosu na vrednosti pre ESE. U kontrolnoj grupi, promene u miokardnoj funkciji tokom ESE bile su izraženije: Ve je povećano za 34,3%, Va za 15,8%, odnos Ve/Va za 15,4% i Vs za 37,8%. Smanjen odgovor miokardne funkcije tokom ESE kod bolesnika s dijabetesom, uslovio je povećanje značajnosti razlike u vrednosti Ve (P<0,001) i značajnu razliku u vrednosti Vs (P<0,001) izmedju bolesnika s dijabetesom i ispitanika kontrolne grupe posle ESE.
Naša studija je pokazala da bolesnici s dijabetesom tip 2 imaju rane znake dominantno dijastolne, a takodje i sistolne disfunkcije miokarda, što se potencira tokom ESE. Ovi znaci mogu se detektovati kvantifikacijom miokardnih brzina primenom DTI, pre pojave kliničkih znakova kardiovaskularnog oboljenja.
Ključne reči: Dijabetes, miokardna funkcija, tkivni Doppler, stres ehokardiografija