avkАрхивъ внутренней медициныThe Russian Archives of Internal Medicine2226-67042411-6564“SINAPS” LLC10.20514/2226-6704-2017-7-2-107-114avk-639Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИORIGINAL ARTICLEХАРАКТЕРИСТИКА СУБКЛИНИЧЕСКОГО ПОРАЖЕНИЯ ЛЕВОГО ЖЕЛУДОЧКА У МОЛОДЫХ ПАЦИЕНТОВ САХАРНЫМ ДИАБЕТОМ 1 ТИПА БЕЗ ИШЕМИЧЕСКОЙ БОЛЕЗНИ СЕРДЦАSUBCLINICAL MYOCARDIAL INJURY OF YOUNG PATIENTS WITH TYPE1 DIABETES MELLITUS WITHOUT CARDIOVASCULAR DISEASEМахаматК.MahamatK.

Кафедра пропедевтики внутренних болезней.

Москва

Department of internal Medicine.

Moscow

МедведевД. А.MedvedevD. A.

Кафедра пропедевтики внутренних болезней.

Москва

Department of internal Medicine.

Moscow

ЕфимоваВ. П.EfimovaV. P.

Отделение функциональной и ультразвуковой диагностики.

Москва

Department of functional and ultrasound diagnostic.

Moscow

СафароваА. Ф.SafarovaA. F.

Кафедра пропедевтики внутренних болезней.

Москва

Department of internal Medicine.

Moscow

aytensaf@mail.ruКобалаваЖ. Д.KobalavaZ. D.

Кафедра пропедевтики внутренних болезней.

Москва

Department of internal Medicine.

Moscow

Российский университет дружбы народовРоссияRUDN UniversityRussian FederationГБУЗ города Москвы «ГКБ №64» ДЗ города Москвы»РоссияClinical Hospital №64 City Health DepartmentRussian Federation20172604201772107114Copyright © Махамат К., Медведев Д.А., Ефимова В.П., Сафарова А.Ф., Кобалава Ж.Д., 20172017Махамат К., Медведев Д.А., Ефимова В.П., Сафарова А.Ф., Кобалава Ж.Д.Mahamat K., Medvedev D.A., Efimova V.P., Safarova A.F., Kobalava Z.D.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.medarhive.ru/jour/article/view/639

Цель: изучить влияние СД 1 типа на структурное и функциональное  состояние левого желудочка  у молодых пациентов  без клиники поражения сердечно-сосудистой системы. В одномоментное  исследование  включены 71 пациент с СД 1 типа без ИБС. Средний возраст пациентов 28,7 лет, 57% мужчин, уровень гликированного  гемоглобина  9,9%, ИМТ 23,4 кг/м2, продолжительность диабета  6,84  лет [0,5; 24], NT-proBNP 62,62 пг/мл, ФВ ЛЖ 61,7%. Всем пациентам был проведен тредмил-тест с целью исключения коронарной патологии. ЭхоКГ исследование включало стандартное исследование с определением ФВ (Simpson method) и продольной систолической функции левого желудочка (GLS) с помощью метода спекл-трекинг (VIVD 7, GE). Субклиническая систолическая дисфункция ЛЖ, определяемая  как GLS <20%, наблюдалась у 63,3% (45/71). Нарушение диастолической функции ЛЖ по типу замедленная релаксация отмечалось у 5,6 (4/45) пациентов СД 1 типа с GLS <20%. Выявлена взаимосвязь для СКФ и GLS (χ2 12,9, р<0,05, r=0,62). При этом относительный риск снижения GLS при СКФ <90 мл/мин /1,73 м2 увеличивался в 2,8 раза (95% ДИ: 1,4;3,2), а при СКФ < 60 мл/мин /1,73 м2 — в 3,4 раза (95% ДИ: 2,3;4,6). Таким образом, ранним маркером субклинического поражения сердца у молодых пациентов СД 1 типа без ИБС является снижение глобальной продольной систолической функции. Также выявлена ассоциация СКФ<90 мл/мин/1,73 м2 со снижением продольной систолической функцией ЛЖ.

The aim: to study the impact of Type1 Diabetes mellitus (DM) on systolic function of left ventricle (LV) of young patients  without  cardiovascular disease (CVD) and identify factors associated with dysfunction of global longitudinal systolic deformation. Young patients with Type1 DM (N=71) and without CVD were included in the study. Mean age was 28,7 years, 57% men, glycated hemoglobin 9,9%, body mass index 23,4 kg/m2, and diabetes duration 6,84 [0,5; 24], NT-proBNP 62,62 pg/ml, LV EF 61,7%. Treadmill test was conducted  to all patients  in order to exclude coronary disease. EchoCG examination including analysis of global longitudinal systolic deformation  by two-dimensional  image. Subclinical systolic dysfunction, that is defined as GLS<20%, was observed in 63,3% cases. Left ventricle diastolic dysfunction with slow relaxation (Type1) was observed in 5,6% patients with Type1 DM and GLS<20%. The correlation  was found for GFR and GLS (χ2  12,9, р<0,05,  r=0,62). At the  same time the  relative risk of GLS decreasing with GFR<90ml/min/1,73m2 increased in 2,8 (OR 2,8; 95% CI: 1,4;3,2;p<0,001), with GFR<60ml/min/1,73m2 increased in 3,4 (OR 3,4; 95% CI: 2,3; 4,6; p<0,001). Conclusions: Global longitudinal systolic LV myocardial deformation is a sensitive marker of subclinical myocardial injury of young patients with Type1 DM without CVD.

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The authors declare that there are no conflicts of interest present.