PubMed日本語 - 心不全の、そして、それのない糖尿病患者における左室収縮機能に関する急性高血糖の効果:2件の無作為クロスオーバー研究。―QLifePro医療翻訳医療翻訳 QLifePro


Effect of acute hyperglycemia on left ventricular contractile function in diabetic patients with and without heart failure: two randomized cross-over studies.


Published date



Roni Nielsen, Helene Nørrelund, Ulla Kampmann, Hans Erik Bøtker, Niels Møller, Henrik Wiggers


Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.


BACKGROUND: It is unknown whether changes in circulating glucose levels due to short-term insulin discontinuation affect left ventricular contractile function in type 2 diabetic patients with (T2D-HF) and without (T2D-nonHF) heart failure.


MATERIALS AND METHODS: In two randomized cross-over-designed trials, 18 insulin-treated type 2 diabetic patients with (Ejection Fraction (EF) 36 ± 6%, n = 10) (trial 2) and without systolic heart failure (EF 60 ± 3%, n = 8) (trial 1) were subjected to hyper- and normoglycemia for 9-12 hours on two different occasions. Advanced echocardiography, bicycle exercise tests and 6-minute hall walk distance were applied.


RESULTS: Plasma glucose levels differed between study arms (6.5 ± 0.8 mM vs 14.1 ± 2.6 mM (T2D-HF), 5.8 ± 0.4 mM vs 9.9 ± 2.1 mM (T2D-nonHF), p<0.001). Hyperglycemia was associated with an increase in several parameters: maximal global systolic tissue velocity (Vmax) (p<0.001), maximal mitral annulus velocity (S'max) (p<0.001), strain rate (p = 0.02) and strain (p = 0.05). Indices of increased myocardial systolic contractile function were significant in both T2D-HF (Vmax: 14%, p = 0.02; S'max: 10%, p = 0.04), T2D-nonHF (Vmax: 12%, p<0.01; S'max: 9%, p<0.001) and in post exercise S'max (7%, p = 0.049) during hyperglycemia as opposed to normoglycemia. LVEF did not differ between normo- and hyperglycemia (p = 0.17), and neither did peak exercise capacity nor catecholamine levels. Type 2 diabetic heart failure patients' 6-minute hall walk distance improved by 7% (p = 0.02) during hyperglycemia as compared with normoglycemia.


CONCLUSIONS: Short-term hyperglycemia by insulin discontinuation is associated with an increase in myocardial systolic contractile function in type 2 diabetic patients with and without heart failure and with a slightly prolonged walking distance in type 2 diabetic heart failure patients. ( identifier NCT00653510).



材料と方法:中で、2つは交差がデザインした試験(2型糖尿病患者をインシュリン扱われる18)(駆出分画(EF)36±6%、n = 10)(試験2)をランダム化して、収縮期性心不全(EF 60±3%、n = 8)(試験1)なしで、2つの異なる場合に9-12時間ハイパー-と正常血糖を受けた。

結果血糖値は、試験群(6.5±0.8mM対14.1±2.6mM(T2D-HF)、5.8±0.4mM対9.9±2.1mM(T2D-nonHF)、p < 0.001)の間に異なった。
高血糖は、いくつかのパラメータの増加と関係していた:最大全体的な収縮期の組織速度(Vmax)(p < 0.001)、最大僧帽弁環速度(S'max)(p < 0.001)、株率(p = 0.02)と株(p = 0.05)。
増加した心筋収縮期の収縮機能のインデックスは、両方のT2D-HF(Vmax:14%、p = 0.02; S'max:10%(p = 0.04))(T2D-nonHF(Vmax:12%、p < 0.01; S'max:9%(p < 0.001)))で、そして、正常血糖と対比しての高血糖の間の柱運動S'max(7%、p = 0.049)で有意だった。
LVEFは正常血糖と高血糖(p = 0.17)の間に異ならなかった、そして、いずれもピークの運動能力もカテコールアミン・レベルもしなかった。
2型糖尿病患者心不全患者の6分のホール散歩距離は、正常血糖と比較して高血糖の間、7%(p = 0.02)改善された。


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