In patients with diabetes and coronary artery disease, the potential negative role of sulfonylurea drugs is under intensive investigation. We assessed the effects of treatment with glibenclamide or insulin on the extension of left ventricular myocardial dysfunction induced by acute ischemia. Nineteen consecutive patients with type 2 diabetes and coronary artery disease entered the study. Each patient was randomly assigned to either insulin or glibenclamide therapy. Treatment was crossed over after 12 weeks and maintained for another 12 weeks. At the end of each treatment, left ventricular myocardial function at rest and during dipyridamole infusion was studied by two-dimensional echocardiography under the same conditions of metabolic control.

Aims: We examined the usefulness of BNP for screening for left ventricular (LV) diastolic dysfunction in a sample of type 2 diabetic patients, without structural heart disorder, who have never presented symptoms or signs of heart failure (HF). Methods and results: Seventy-six consecutive patients admitted to the Outpatient Diabetes Clinic were studied. Blood samples were analyzed using the Triage BNP fluorescence immunoassay (Biosite Diagnostics, La Jolla, CA, USA). Echocardiography examinations were performed, with no knowledge of the BNP value. A total of 39 patients out of 76 (51%) were diagnosed with LV diastolic dysfunction and 23 (30%) with LV hypertrophy. Of the patients with LV diastolic dysfunction, impaired relaxation and pseudonormal pattern accounted for 97 and 3% of the cases, respectively. BNP levels among subjects with LV diastolic dysfunction (26 G 22 pg/ml, n Z 39) were not significantly different from patients with normal LV function (24 G 23 pg/ml, n Z 37 pg/ml; ManneWhitney U-test, Z Z ÿ0.4, n.s.). Conclusions: Our data confirm alarmingly high prevalence of LV diastolic dysfunction in asymptomatic individuals with diabetes. Identification of patients with preclinical diabetic cardiomyopathy should be a research and clinical priority. BNP levels cannot be used to detect mild LV diastolic dysfunction in this subset of patients, which requires Doppler echocardiography to be detected.

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Preclinical abnormalities of left ventricular function are frequently found in chronic alcoholics. In 12 chronic alcoholics without cardiomyopathy and in 12 healthy controls, systolic time intervals and echocardiograms were investigated before and after 12 months of abstinence from alcohol. In chronic alcoholics, an increase was found in the PEP/LVET ratio (0.31 ± 0.06; in controls 0.24 ± 0.05; t = 3.11; p < 0.005), the diastolic interventricular septal thickness (6.0 ± 2.0 mm/m²; in controls 4.1 ± 1.0; t = 2.95; p < 0.01), the left ventricular wall thickness (6.3 ± 1.0 mm/m²; in controls 4.9 ± 1.0; t = 3.43; p < 0.005) and the left ventricular diastolic dimension (29 ± 4 mm/m²; in controls 26 ± 3; t = 2.08;p < 0.05). The left ventricular mass (135 ± 33 g/m²; in controls 113 ± 40; t= 1.47) did not differ from the controls. After 12 months of abstinence a significant decrease was found in the PEP/LVET ratio (0.26 ± 0.05, i.e. -16%; t = 3.59; p < 0.005), the diastolic interventricular septal thickness (4.7 ± 0.9 mm/m², i.e. -22%; t = 2.73; p < 0.02), the left ventricular posterior wall thickness (5.6 ± 1.0 mm/m², i.e. -11 %; t = 4.08; p < 0.001) and the left ventricular mass (109 ± 24 g/m², i.e. -21 %; t = 6.53; p < 0.001). The left ventricular diastolic dimension (27 ± 2 mm/m², i.e. -7%; t = 1.3) did not change. In conclusion, in chronic alcoholics, the abstinence from alcohol can be followed by an improvement of left ventricular function.

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