Pathogenetic changes of the residual myocardium associated with NIDDM may adversely influence the process of left ventricular remodeling after MI, especially in patients with increased left ventricular EDV.

Left ventricular diastolic filling properties during isometric handgrip exercise were measured by pulsed Doppler echocardiography in 33 noninsulin-dependent diabetic patients with a normal ejection fraction and 15 control subjects. Diabetic patients were subdivided into two groups according to their resting left ventricular filling pattern (A/E): 18 patients were in group DM-1 (A/E ≤ 1.1) and 15 patients were in group DM-2 (A/E > 1.1). At rest, A/E ratio and A wave were higher, and deceleration half-time was longer in group DM-2 than in normal subjects and group DM-1, but there was no significant difference between normal subjects and group DM-1. The A/E ratio increased significantly in all three groups during isometric handgrip exercise. However, the change in A/E from rest to peak exercise in group DM-1 (0.29 ± 0.20) was significantly greater than in normal subjects (0.09 ± 0.07). These results suggest that diabetes mellitus patients with normal resting left ventricular (LV) filling pattern (group DM-1) had LV diastolic filling abnormalities with isometric handgrip exercise. Doppler echocardiography with isometric handgrip exercise is useful in identifying underlying left ventricular diastolic dysfunction in diabetic patients.

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To elucidate the pathophysiological role of diabetes mellitus in determining the left ventricular regional function of the noninfarcted area, 55 patients with acute Q wave anterior myocardial infarction (MI) were studied. The regional ejection fraction of the noninfarcted area was obtained by radionuclide angiocardiography and was used to estimate the left ventricular regional function of the noninfarcted area. Multiple regression analysis was performed to determine the important variables contributing to the regional ejection fraction based on 10 clinical variables: age, sex, QRS score, diabetes mellitus, hypertension, smoking, postinfarction angina, body mass index, serum cholesterol, and coronary atherosclerosis. A high QRS score (P less than .001) and the association of diabetes mellitus (P less than .05) were the important factors contributing to regional left ventricular dysfunction. The regional ejection fraction and QRS score had an inverse linear relationship in the diabetic and nondiabetic groups, and the regional ejection fraction was significantly lower in diabetic patients at every QRS score (P less than .05). The association of hypertension, severity of coronary atherosclerosis, serum cholesterol level, age, and body mass index did not differ between diabetic and nondiabetic patients, which indicates that diabetes mellitus was not mediated through these atherogenic traits. Thus, diabetes mellitus is another discrete cause of regional left ventricular dysfunction of the noninfarcted area after acute MI.