心力衰竭糖尿病患者急性心肌梗死后无法回避的难题.ppt

糖尿病患者急性心肌梗死后死亡 Survival improvements. Kaplan–Meier survival curves from 1995 and 2003 are displayed for cohorts with and without DM. The highlighted area refers to survival improvement within each group between 1995 and 2003 糖尿病患者PCI术后 Measurements of epicardial coronary flow, myocardial reperfusion, and final infarct size for diabetic patients (white bars) and nondiabetic patients (black bars) Am J Cardiol 2007;100:206 –210 Adjusted myocardial blood flow (MBF) reserve measured by PET Circulation 2005;111:2291-2298 IS IR IGT T2DM T2DM+HT 0.0 1.0 2.0 3.0 *** *** *** p0.001 p=0.002 MBF, mL ·min-1 ·g-1 Coronary circulatory dysfunction worsens with increasing severity of insulin resistance Endothelial dysfunction in Type 2 diabetes is characterized by unbalanced activity of vascoactive factors Circulation 2002;106:1783 Circulation 1999;100:820 Diabetes 2002;51:3517 Vasodilators Vasoconstrictors NO (eNOS) Prostacyclin (COX) Endothelin-1 Insulin mediated myocardium glucose uptake measured by PET Diabetes 2002;51:3020-30 Control CAD T2DM CAD+T2DM 0.0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 Myocardial glucose uptake (mmol·min-1 ·g-1) *** *** *** ***p0.001 Independent association of Type 2 diabetes and CAD with myocardial insulin resistance Insulin resistance as a predictor of the severity and extend of CAD Graner M et al. Unpublished 1.8 ? 1.8 Type 2DM 20 40 1.8 ? 1.8 Type 2 DM 10 20 Global PDS index Global extend index Insulin resistance is associated with increased severity and extent of CAD HOMA-IR HOMA-IR The risk of CHF in patients with diabetes Circulation 2001;103;2668-2673 7 7 to8 8 to9 9 to 10 10 0 2 4 6 8 10 Hemoglobin A1c (%) CHF Rate/Year per 1000 Each 1% increase in HbA1c is associated with 8% increased risk of HF n=48858 p0.0001 * 心力衰竭 --糖尿病患者急性心肌梗死后无法回避的难题 吴永健 中国医学科学院 中国协和医科大学 心血管病研究所 阜外心血管病医院 糖尿病患者急性心肌梗死后心力衰竭 The prevalence of heart failure is about 12% in people with Type 2 diabetes as compared to only 3.2% in non-diabetic