Diastolic Dysfunction in Normotensive Men with Well-Controlled Type 2 Diabetes

Abstract

Abbreviations: CAD, coronary artery disease; IVRT, isovolumetric relaxation time; LVDD, left ventricular diastolic dysfunction; MET, metabolic equivalent; PST, posterior wall thickness; PVa, pulmonary reversed A wave velocity; PVd, pulmonary D wave velocity; PVs, pulmonary S wave velocity.A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances. Diastolic Dysfunction in Normotensive Men With Well-Controlled Type 2 DiabetesImportance of maneuvers in echocardiographic screening for preclinical diabetic cardiomyopathyOBJECTIVE -Because a pseudonormal pattern of ventricular filling has never been considered in studies that reported a prevalence of left ventricular diastolic dysfunction (LVDD) between 20 and 40%, our aim was to more completely evaluate the prevalence of LVDD in subjects with diabetes.RESEARCH DESIGN AND METHODS -We studied 46 men with type 2 diabetes who were aged 38-67 years; without evidence of diabetic complications, hypertension, coronary artery disease, congestive heart failure, or thyroid or overt renal disease; and with a maximal treadmill exercise test showing no ischemia. LVDD was evaluated by Doppler echocardiography, which included the use of the Valsalva maneuver and pulmonary venous recordings to unmask a pseudonormal pattern of left ventricular filling.RESULTS -LVDD was found in 28 subjects (60%), of whom 13 (28%) had a pseudonormal pattern of ventricular filling and 15 (32%) had impaired relaxation. Systolic function was normal in all subjects, and there was no correlation between LVDD and indexes of metabolic control.CONCLUSIONS -LVDD is much more common than previously reported in subjects with well-controlled type 2 diabetes who are free of clinically detectable heart disease. The high prevalence of this phenomenon in this high-risk population suggests that screening for LVDD in type 2 diabetes should include procedures such as the Valsalva maneuver and pulmonary venous recordings to unmask a pseudonormal pattern of ventricular filling.

Determinants of subclinical diabetic heart disease

“…These clinical findings are consistent with previous studies with diabetes in animals [12] and humans [13]. Failure to identify this in previous studies in type 2 diabetes [14] probably reflects the use of less sensitive markers of LV function. Myocardial dysfunction in diabetes may be functional-resulting from alterations in substrate supply and utilisation, elevated NEFA levels and abnormalities in regulation of calcium homeostasis.…”

Involvement of RhoA/ROCK in myocardial fibrosis in a rat model of type 2 diabetes

“…DMinduced cardiac remodeling may participate in diastolic and systolic dysfunction, leading to congestive heart failure. Moreover, it can occur during the early stages of DM [1,2] , and is closely related to a high prevalence of mortality from cardiovascular events in DM. However, specific drugs for the prevention or treatment of diabetic cardiomyopathy are not available.…”

Köpeklerde Geriatrik Kardiyoloji - Bölüm 2: Geriatrik Köpeklerde Kalp Yetmezliği Tedavisinde Zorluklar: İlaç Reaksiyonları ve Komorbitler

“…At the cellular level, diabetic cardiomyopathy is associated with defects in subcellular organelles and downregulation of catecholamine receptors as a result of chronically elevated catecholamine levels [26] . Also, in animal models with the onset of hyperglycemia, changes in myocardial calcium transportation and alterations in contractile proteins occur, both of which lead to systolic and diastolic dysfunction that worsens as the collagen content of the myocardium increases [27] . Doppler imaging studies have been used to provide load-independent assessments of cardiac relaxation.…”