Longitudinal Development of Left Ventricular Diastolic Function in Patients With Type 2 Diabetes

Abstract

OBJECTIVELeft ventricular diastolic dysfunction (LVDD) is considered to be common in patients with type 2 diabetes mellitus (T2DM), but information on its progression over time is lacking. We studied the longitudinal development of left ventricular diastolic function (LVDF) and myocardial blood flow reserve in patients with T2DM who were free from clinically detectable cardiovascular disease. RESEARCH DESIGN AND METHODSThe LVDF was assessed in 73 patients with T2DM (mean age 67 6 7 years; males 51%) on two occasions separated by 6.4 6 0.8 years. RESULTSAt baseline, LVDD was observed in 23 of the patients (32%). During follow-up, the LVDF normalized in 10 of these patients (43%) and remained unchanged in 13 of them (57%). Of the 50 patients (68%) with normal LVDF at baseline, LVDD developed in 9 (18%). Paired evaluation of myocardial blood volume index was available from 22 patients with LVDD and remained unchanged over time. CONCLUSIONSThe condition of the majority of the investigated patients with LVDD improved or remained stable over a period of 6 years.Myocardial dysfunction, in particular relaxation disturbances, occurs in patients with type 2 diabetes even in the absence of such conditions as hypertension and coronary artery disease (1). The background structural and functional changes relate to glucometabolic perturbations (2,3), but factors such as increasing age, obesity, hypertension, and coronary artery disease may also contribute to myocardial stiffness (4), and often coexist in patients with diabetes.Left ventricular diastolic dysfunction (LVDD) is characterized by echocardiographic indices of impaired early diastolic filling, prolonged isovolumetric relaxation (5), and also, in more advanced stages, increased atrial volume (6). It has been referred to as a progressive condition increasing the risk for subsequent overt heart failure and compromised survival (7,8). The prevalence of LVDD in patients with type 2 diabetes has been estimated to be between 35% and 60% (9-11). The wide range is mainly explained by varying definitions of LVDD, applied echocardiographic techniques, and population characteristics. Considering the rather high prevalence of LVDD, a better understanding of its time-dependent development may identify high-risk populations as well as create opportunities to prevent or at least delay its progression. However, longitudinal studies of the natural course of left ventricular diastolic function (LVDF) in patients with type 2 diabetes who were free

Impact of dapagliflozin on left ventricular diastolic function of patients with type 2 diabetic mellitus with chronic heart failure

“…This is followed by a late stage, which is characterized by alteration in microvasculature compliance, an increase in LV size, and a decrease in cardiac performance leading to symptomatic HF. Predictors for progression to the late stage, which may take several years, include comorbidities often seen in T2DM such as coronary artery disease, hypertension, overweight/obesity, and microvascular changes [ 19 ].…”

Left ventricular diastolic dysfunction in diabetes mellitus and the therapeutic role of exercise training

“…Other studies found no independent correlation between alteration of diastolic function and poor glycemic control (19,23). Women seem to be more predisposed than men to develop LVDD (10,15,26). Moreover, in middleaged and elderly Korean patients at risk of developing CAD, the correlation between metabolic syndrome components and LVDD was more pronounced in women than in men, suggesting a possible role of sex hormones in metabolic syndrome associated LV diastolic function alterations (30).…”

“…When patients had both diabetes and HT, a higher LV end-diastolic pressure was found compared with either condition alone, suggesting an additional risk for the occurrence of LVDD in these patients compared to those with HT alone (25). Nevertheless, in patients without concomitant disease such as HT and CAD, followed up for 6 years, the authors reported that the prevalence of LVDD was relatively low, suggesting that in the early stage of LVDD, there may be a slow progression of myocardial changes (26). Duration of diabetes, age and abnormally elevated levels of Hb1AC were independently correlated with LVDD in several studies (15,21,27,28,29).…”

G protein‐coupled receptor kinase‐2: A potential biomarker for early diabetic cardiomyopathy

“…Cardiomyocyte apoptosis and myocardial fibrosis are the early major pathological changes of DCM. Although the exact prevalence of DCM is unknown, the incidence of diastolic dysfunction in patients with T2DM is up to 30% in some studies . Accumulating evidence suggests that left ventricular diastolic dysfunction (LVDD) is the earliest clinical manifestation of DCM, and LVDD implies cardiac tissue remodeling.…”

“…Although the exact prevalence of DCM is unknown, the incidence of diastolic dysfunction in patients with T2DM is up to 30% in some studies. 5 Accumulating evidence suggests that left ventricular diastolic dysfunction (LVDD) is the earliest clinical manifestation of DCM, and LVDD implies cardiac tissue remodeling. Poirier and his colleagues found that about 60% of T2DM patients without hypertension and cardiovascular diseases were found with LVDD by cardiac tissue Doppler.…”