Factors Contributing to Left Ventricular Diastolic Dysfunction in Long‐term Type I Diabetic Subjects

Abstract

Although non‐invasive studies in type I diabetic subjects indicate left ventricular (LV) diastolic dysfunction, the contribution of borderline or mild hypertension to such changes is obscure. Thus, digitized M‐mode echocardiograms were obtained in 32 (18 men) young (<50 years) normotensive controls and 32 (21 men) long‐term (≥12 years) type I diabetics with blood pressures ranging from normal to hypertensive. All diabetics were without clinical heart disease, none were previously treated for hypertension or using cardioactive drugs. Heart rate, systolic and diastolic blood pressures were higher in diabetic than control subjects. Their LV end‐diastolic dimension was smaller, whereas wall thickness, LV mass index and fractional shortening were similar to controls. In diabetics, however, the normalized peak filling rate was decreased and the rapid filling period fraction of diastole increased. In multivariate analysis, diabetes and LV mass independently and inversely influenced the normalized peak filling rate, while fractional shortening did so positively. Furthermore, diabetes and systolic blood pressure independently influenced the rapid filling period fraction of diastole. This study is the first to demonstrate systolic blood pressure and LV mass as independent contributors to subclinical LV diastolic abnormalities in diabetics. These findings may therefore indicate the need to treat even mild hypertension in diabetics in an effort to delay the development of cardiopathy.

ISPAD Clinical Practice Consensus Guidelines 2018: Microvascular and macrovascular complications in children and adolescents

“…Previous studies in diabetic adults have shown that aerobic capacity and left ventricular stroke volume during exercise are associated with diastolic dysfunction in adults. 152,154 Adults with asymptomatic type 1 diabetes have reduced exercise capacity and lower stroke volume at peak exercise compared with non-diabetic peers, limitations that are strongly associated with diastolic dysfunction 154,155 and reduced EDV during exercise. 152,154 Current evidence suggests that healthy adolescents with diabetes may also have lower aerobic capacity 156,157 and lower exercise stroke volume.…”

“…152,154 Adults with asymptomatic type 1 diabetes have reduced exercise capacity and lower stroke volume at peak exercise compared with non-diabetic peers, limitations that are strongly associated with diastolic dysfunction 154,155 and reduced EDV during exercise. 152,154 Current evidence suggests that healthy adolescents with diabetes may also have lower aerobic capacity 156,157 and lower exercise stroke volume. 156 In a recent study, 52 adolescents with type 1 diabetic (mean duration of diabetes was 6 years) were assessed at rest and during submaximal exercise (at a fixed heart rate) by cardiac magnetic resonance imaging (MRI).…”

Microvascular and macrovascular complications in children and adolescents

“…Previous studies in diabetic adults have shown that aerobic capacity and left ventricular stroke volume during exercise are associated with diastolic dysfunction in adults (118,119). Adults with asymptomatic type 1 diabetes have reduced exercise capacity and lower stroke volume at peak exercise compared with non-diabetic peers, limitations that are strongly associated with diastolic dysfunction (119, Microvascular and macrovascular complications 120) and reduced EDV during exercise (118,119). Current evidence suggests that healthy adolescents with diabetes may also have lower aerobic capacity (121,122) and lower exercise stroke volume (121).…”

Diastolic Function Is Reduced in Adolescents With Type 1 Diabetes in Response to Exercise

“…Previous studies in diabetic adults showed that aerobic capacity and left ventricular stroke volume during exercise are associated with diastolic dysfunction in adults (5,6). Adults with asymptomatic type 1 diabetes have reduced exercise capacity and lower stroke volume at peak exercise compared with nondiabetic peers, limitations that are strongly associated with diastolic dysfunction (6,7) and reduced EDV during exercise (5,6). It remains unclear whether diabetic adolescents present similar alterations in left ventricular function.…”