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Association entre tissu adipeux epicardique et dysfonction systolique infraclinique détectée par strain longitudinal chez les diabétiques mal équilibrés

F. Aboukhoudir, S. Rekik, M. Pansieri, P. Obert

Publication date: November 2018

Source: Annales de Cardiologie et d'Angéiologie, Volume 67, Issue 5

Author(s): F. Aboukhoudir, S. Rekik, M. Pansieri, P. Obert

Résumé
Objectif

Déterminer chez les patients diabétiques mal équilibrés l’association entre tissu adipeux épicardique et cardiomyopathie diabétique débutante infraclinique détectée par les paramètres échocardiographiques et notamment le strain longitudinal.

Patients et méthodes

22 patients diabétiques mal équilibrés et 22 patients témoins ont été prospectivement recrutés ; les différents paramètres échocardiographiques incluant le strain et l’épaisseur du tissu adipeux épicardique (TAE) ont été recueillies.

Résultats

Comparativement aux témoins, les patients diabétiques avaient un indice de masse corporel (27,7 vs. 24,6 ; p < 0,01), un tour de taille (103 vs. 84 ; p < 0,001) et un niveau de CRPus (5,4 vs. 1,5 ; p < 0,01) significativement plus élevés. Echocardiographiquement ; aucune différence n’a été notée en terme de fraction d’ejection ou de masse indexée ; en revanche ; les diabétiques avaient un TAE significativement plus important (8,7 ± 0,7 vs. 3,0 ± 1,0 ; p < 0,001) et un strain longitudinal plus altéré (−18,8 ± 3,2 vs. −22,3 ± 1,6 ; p < 0,001). Une analyse de régression multiple fait apparaître le TAE (β = 0,46, p = 0,001) comme contributeur indépendant du strain global.

Conclusion

Chez le diabétique mal équilibrés le volume du TAE est associé à une dysfonction systolique myocardique détectée par le strain longitudinal et ce, malgré l’absence d’altération de la FEVG et de coronaropathie sous-jacente.

Abstract
Objective

The aim of this study is to assess the association between epicardial adipose tissue (EAT) and infraclinical myocardial dysfunction detected by strain imaging in diabetic patients (T2DM) with poor glycemic control.

Methods

22 patients with T2DM and 22 healthy control subjects of similar age and sex were prospectively recruited. Echocardiographic parameters were investigated.

Results

In comparison to controls, diabetic patients had significantly higher body mass index (27.7 vs. 24.6; P < 0.01), waist perimeter (103 vs. 84; P < 0.001) and usCRP level (5.4 vs. 1.5; P < 0.01). On echocardiography; no differences were found in terms of ejection fraction or ventricular mass; however, patients with T2DM had significantly thicker EAT (8.7 ± 0.7 vs. 3.0 ± 1.0; P < 0.001) and altered systolic longitudinal strain (−18.8 ± 3.2 vs. 22.3 ± 1.6; P < 0.001). On multivariate analysis, EAT was identified as an independent contributor (β=0,46, P = 0.001) to systolic longitudinal strain.

Conclusion

In patients with T2DM and poor glycemic control; EAT was associated with infraclinical systolic dysfunction evaluated by global longitudinal strain despite normal at rest ejection fraction and no coronary artery disease.

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