Left Ventricular Function in Insulin-Dependent and in Non-Insulin-Dependent Diabetic Patients: Radionuclide Assessment

Abstract

The aim of this study was to compare, by gated radionuclide angiography, systolic and diastolic ventricular function in insulin-dependent (IDDM) and non-insulin-dependent (NIDDM) diabetic patients without overt cardiovascular disease. The study population consisted of 20 IDDM patients (15 male, 5 female; 40.7 ± 10.3 years), 14 NIDDM patients (9 male, 5 female; 47.0 ± 7.5 years) and 12 healthy subjects (7 male, 5 female; 41.5 ± 6.3 years) as a control (C) group. The duration of diabetes (DD) and glycosylated hemoglobin (HbA_1c) levels were significantly higher in the IDDM patients. The ventricular ejection fraction and peak ejection rate (PER) were assessed by gated radionuclide left ventriculography and were similar in three groups, while the peak filling rate (PFR) was lower in the NIDDM patients compared to the IDDM patients (p < 0.05) and controlled healthy subjects (p < 0.01, IDDM = 3.39 ± 1.14; NIDDM = 2.65 ± 0.83; C = 3.55 ± 0.73), the time to PFR was significantly more prolonged in the NIDDM group than in the IDDM (p < 0.05) and C groups (p < 0.05, NIDDM = 162 ± 26; IDDM = 140 ± 28; C = 142 ± 23). The PFR/PER ratio was near the normal value (-1) in the IDDM patients and controlled subjects, while in the NIDDM patients it was reduced ( = 0.84 ± 0.18). Seven IDDM and 4 NIDDM patients had borderline signs of cardiovascular autonomic neuropathy, unrelated to DD, HbAic and scintigraphic parameters. Left ventricular systolic performance was substantially normal and similar in both the IDDM and NIDDM patients. Ventricular diastolic filling was impaired in the NIDDM patients, as shown by the decrease in PFR and in particular in the PFR/PER ratio. Our radionuclide data suggest that the NIDDM patients had a prevalent abnormality of ventricular diastolic performance, with respect to the IDDM patients, although the latter patients had higher DD and HbA_1c values.

Role of Podocyte B7-1 in Diabetic Nephropathy

“…11 Multiple trials based on CTLA4-Ig are currently ongoing, 31,32 with almost 2000 individuals already treated and an overall rate of side effects comparable to the placebo arm. 11,33 We acknowledge that different limitations are present in our study. First, we did not demonstrate a major salutary effect of CTLA4-Ig on DN.…”

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

“…Several studies have shown a correlation between glycemic control and LVDD, with associated improvement in cardiac function after adequate treatment (7,(15)(16)(17). However, other studies have found no such correlation (4,6,11,18).…”

Reversal of left ventricular diastolic dysfunction after kidney-pancreas transplantation in type 1 diabetic uremic patients.

“…A systolic dysfunction in normotensive diabetic patients was not clearly shown, although a decrease in fractional shortening and an increase of left ventricular mass were reported (3). Abnormality in diastolic dysfunction has been more uniformly observed in asymptomatic diabetic patients with an altered diastolic filling, as shown by impaired values of peak filling rate and timeto-peak filling rate (4). The relationship between diastolic dysfunction and metabolic control in type 1 diabetic patients is still a matter of debate (4).…”

“…Abnormality in diastolic dysfunction has been more uniformly observed in asymptomatic diabetic patients with an altered diastolic filling, as shown by impaired values of peak filling rate and timeto-peak filling rate (4). The relationship between diastolic dysfunction and metabolic control in type 1 diabetic patients is still a matter of debate (4). Studies involving the reversal of diabetic cardiomyopathy after tight glycemic control in type 1 diabetes are lacking.…”