Comprehensive echocardiographic and biomarker assessment of patients with diabetic ketoacidosis.

Autor: Carrizales-Sepúlveda EF; Cardiology Service, Hospital Universitario 'Dr. José E. González', Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico. edgar.carri_89@hotmail.com.; Heart Failure Unit, Cardiology Service, Hospital Universitario 'Dr. José E. González', Universidad Autónoma de Nuevo León, Madero and Gonzalitos Av N/N, Mitras Centro, 64460, Monterrey, Nuevo León, Mexico. edgar.carri_89@hotmail.com., Ordaz-Farías A; Cardiology Service, Hospital Universitario 'Dr. José E. González', Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico.; Echocardiography Laboratory, Cardiology Service, Hospital Universitario 'Dr. José E. González', Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico., Vera-Pineda R; Cardiology Service, Hospital Universitario 'Dr. José E. González', Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico., Rodríguez-Gutierrez R; Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA.; Endocrinology Division, Hospital Universitario 'Dr José E. González, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico.; Plataforma INVEST Medicina-UANL-KER Unit, KER Unit México, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico., Flores-Ramírez R; Cardiology Service, Hospital Universitario 'Dr. José E. González', Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico.; Echocardiography Laboratory, Cardiology Service, Hospital Universitario 'Dr. José E. González', Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico.; Heart Failure Unit, Cardiology Service, Hospital Universitario 'Dr. José E. González', Universidad Autónoma de Nuevo León, Madero and Gonzalitos Av N/N, Mitras Centro, 64460, Monterrey, Nuevo León, Mexico.
Jazyk: angličtina
Zdroj: Cardiovascular diabetology [Cardiovasc Diabetol] 2024 Oct 28; Vol. 23 (1), pp. 385. Date of Electronic Publication: 2024 Oct 28.
DOI: 10.1186/s12933-024-02471-0
Abstrakt: Background: Systemic stress, inflammation, and hydroelectrolytic and acid‒base abnormalities observed during diabetic ketoacidosis (DKA) can cause changes in the heart and even induce cardiovascular damage. We aimed to evaluate the structure and function of the heart during and after a DKA episode via echocardiography and biomarker assessment.
Methods: We performed a transthoracic echocardiogram (TTE) in subjects with an episode of DKA in the first 4-6 h of treatment. We evaluated left ventricular wall thickness, diameters and volumes, as well as systolic and diastolic function using tissue Doppler imaging, pulsed wave Doppler and left ventricular ejection fraction (LVEF). Left ventricular function was also assessed with global longitudinal strain (GLS). We obtained cardiac troponin levels in the first 24 h after admission. A second TTE was performed following the same protocol 6-12 h after the resolution of the DKA episode.
Results: We included a total of 20 subjects. The mean age was 33 ± 13.6 years; 70% were female, and 70% had type 1 DM. 75% of the patients experienced severe episodes, and the rest experienced moderate episodes. Left ventricular isovolumetric contraction and ejection time were significantly shorter during DKA and prolonged after the resolution of the episodes (47.6 ± 9.9 vs. 62.2 ± 14.1, p = < 0.001) and (218.6 ± 37.9 vs. 265.06 ± 34.7). The isovolumetric relaxation time was also shorter during DKA, (41.72 ± 8.29 vs. 59.32 ± 17.98, p = < 0.001). Volumes and diameters of the left ventricle increased significantly after DKA resolution. We found no difference between LVEF or GLS during and after DKA resolution. 20% of the participants had troponin elevations, half of whom had moderate episodes and half of whom had severe episodes. 35% had LV dysfunction, 28.5% both in GLS and LVEF. 28.5% occurred after DKA resolution, with alterations in GLS.
Conclusions: Diabetic ketoacidosis induces changes in the structure and function of the heart, which are mostly transient, reflect the presence of a hyperdynamic state and resolve after the resolution of the episode. Some subjects present with evidence of myocardial injury with elevated cardiac troponin and left ventricular dysfunction.
(© 2024. The Author(s).)
Databáze: MEDLINE
Externí odkaz:
Nepřihlášeným uživatelům se plný text nezobrazuje