老年2型糖尿病患者常暗藏心力衰竭

罗马——欧洲心脏病学会(ESC)主办的2013欧洲预防大会上报告的一项研究显示，老年2型糖尿病患者常有未被诊断的心力衰竭。

这项由荷兰乌得勒支大学医学中心的Leandra J.M. Boonman-de Winter医生及其合作者进行的研究共纳入581例荷兰2型糖尿病患者。这些受试者年龄均≥60岁，既往无心力衰竭病史。研究者通过对其进行全面筛查和评估，查出161例合并心力衰竭的患者(28%)，包括28例(占5%)左室功能下降和133例(23%)左室功能保留。为了查出这些心力衰竭病例，研究者们对每例2型糖尿病患者均进行了全面检查，包括询问病史、体格检查、心电图(ECG)以及超声心动图，并由一个心脏病专家组采用欧洲心脏病学会的诊断标准对心力衰竭进行诊断(Eur. Heart J. 2012;33:1787-847)。

另外，研究者们还进行了一项多变量分析，以识别与这些糖尿病患者存在心力衰竭有显著相关性的人口学和临床因素。呼吸困难或疲乏与心力衰竭发病风险增加6倍有关；踝部水肿或夜尿、缺血性心脏病以及年龄＞75岁中的每项因素都与心力衰竭风险加倍有关；高血压与心力衰竭风险增加75%有关。在这些2型糖尿病患者中查出的心力衰竭可能有80%是由这5项因素综合导致，故研究者建议使用这5项因素对老年糖尿病患者进行心力衰竭筛查。

Boonman-de Winter医生及其合作者无利益冲突披露。

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By: MITCHEL L. ZOLER, Cardiology News Digital Network

ROME  – Unrecognized heart failure is common among older patients with type 2 diabetes, on the basis of a study of 581 Dutch diabetes patients.

A comprehensive screening examination and assessment of Dutch patients with type 2 diabetes who were at least 60 years old and had no prior history of heart failure identified 161 patients (28%) with heart failure, Dr. Leandra J.M. Boonman-de Winter and her associates reported in a poster at the European Society of Cardiology annual meeting.

The newly identified heart failure patients included 28 (5% of the total group screened) with reduced left ventricular function and 133 (23%) with preserved left ventricular function, said Dr. Boonman-de Winter, a researcher at University Medical Center in Utrecht, the Netherlands, and her associates.

To identify these heart failure cases, the researchers performed an extensive work-up on each patient with type 2 diabetes, including a medical history, physical examination, ECG, and echocardiography. A panel of expert cardiologists made the diagnosis of heart failure using criteria of the European Society for Cardiology (Eur. Heart J. 2012;33:1787-847).

The researchers also performed a multivariate analysis to identify demographic and clinical factors that significantly linked with the presence of heart failure in the patients with diabetes. Dyspnea or fatigue linked with a sixfold increased prevalence of heart failure; ankle edema or nocturia, a history of ischemic heart disease, and age greater than 75 years old each linked with a doubled heart-failure prevalence; and hypertension linked with a 70% increased prevalence of heart failure.

These five factors together could account for 80% of the heart failure cases found among the patients with type 2 diabetes, the researchers reported. They recommended using these five factors to identify older patients with diabetes to more thoroughly screen for heart failure.

Dr. Boonman-de Winter and her associates said that they had no disclosures.