Isolated Type 2 Diabetes mellitus Causes Myocardial Dysfunction That Becomes Worse in the Presence of Cardiovascular Diseases: Results of the Myocardial Doppler in Diabetes (MYDID) Study 1

Abstract

Aims: Patients with type 2 diabetes mellitus (DM) often suffer disproportionately and have a worse outcome when burdened with cardiovascular complications compared with those without DM. A specific heart muscle disease reportedly caused by DM per se may explain this. We sought to investigate whether an echo Doppler diagnosis of such a myocardial disease is clinically relevant in DM with or without coexistent coronary artery disease (CAD) and/or hypertension (HTN). Subjects andMethods: Two hundred subjects (127 males, 73 females, 56 ± 10 years) including controls (n = 23), patients with HTN (n = 20), CAD (n = 35), uncomplicated DM (n = 59), DM+HTN (n = 27), DM+CAD (n = 16) and DM+CAD+HTN (n = 20) underwent tissue Doppler-enhanced dobutamine stress echocardiography. Myocardial function was assessed by measuring left ventricular myocardial peak systolic velocity (PSV) and early diastolic velocity at rest and during peak stress, besides measurements of standard Doppler variables. Results: Average left ventricular PSV at rest was significantly lower in CAD (4.7 ± 1.5) compared with controls (5.7 ± 1.2) and in DM+CAD+HTN (4.6 ± 1.4) compared with DM (5.6 ± 1.3; all p < 0.05). During peak stress, lower PSV persisted in CAD (9.5 ± 3.1) and DM+CAD+HTN (8.1 ± 2.7), while appearing de novo in DM (11.3 ± 2.6) and HTN (11.0 ± 2.3) unlike in the controls (12.5 ± 2.5; all p < 0.001). When pooled together, DM subjects with CAD and/or HTN or both had significantly lower PSV (9.1 ± 2.7) than those without (10.0 ± 2.8; p < 0.001). Early diastolic velocity response was equally lower in both groups compared with the controls. Conclusion: The results suggest that dobutamine stress unmasks myocardial functional disturbances caused by uncomplicated DM. The discrete disturbances become quantitatively more pronounced in the presence of coexistent cardiovascular diseases.

Differing myocardial response to a single session of hemodialysis in end-stage renal disease with and without type 2 diabetes mellitus and coronary artery disease

“…A PC-based version of STATISTICA version 6.0 was used for data analyses. Intra-observer variation was similar to our previous study [ 11 ]. All continuous variables are expressed as mean ± SD.…”

Left Ventricular Function in Children and Adolescents With Type 1 Diabetes Mellitus

“…Although it is difficult to clinically identify whether hyperglycemia is associated with myocardiac dysfunction in patients with DM, recent echocardiographic studies have shown that correlations exist between the state of glycemic control and ventricular function. Recent studies involving adult patients with type 2 DM showed that hyperglycemia influences on LV systolic function, especially with respect to ventricular long axis function 18)19). A study using magnetic resonance imaging indicates that there is a correlation between hyperglycemia and LV function in type 1 DM as well 20).…”

Microalbuminuria and left ventricular function in type 2 diabetes: A quantitative assessment by stress echocardiography in the Myocardial Doppler in Diabetes (MYDID) Study III

“…Since left ventricular (LV) structure and function might be altered in type 2 diabetes even in the absence of cardiovascular disease, presence of coexistent microalbuminuria in DM may be an early marker of or contribute to more severe LV dysfunctions. Previous studies from our group have suggested that uncomplicated DM may decrease LV myocardial functional reserve, which could be further compromised when associated with systemic arterial hypertension (HTN) or coronary artery disease (CAD) or their combination (2,3). Also shown is the independent association in non-diabetics between MA and surface electrocardiogram (ECG) showing ischemic abnormalities, suggesting that MA has additional value to conventional risk indicators in predicting cardiovascular disease (4).…”