Quantification of diastolic dysfunction via the age dependence of diastolic function — Impact of insulin resistance with and without type 2 diabetes

Bibra, H. von; Paulus, Walter; Sutton, M. St. John; Leclerque, Caterina; Schuster, Tibor; Schumm–Draeger, Petra–Maria

doi:10.1016/j.ijcard.2014.12.005

Cited by 34 publications

(53 citation statements)

References 30 publications

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“…Applying this equation and the lower 95% tolerance interval as previously described [20], we identified 44 T2DM patients (35.2%) and 8 healthy volunteers (7.9%; P < 0.0001) having diastolic dysfunction.…”

Section: Resultsmentioning

confidence: 99%

“…LV diastolic dysfunction is an early manifestation of diabetic heart disease [1, 20, 21], and a subclinical impairment of diastolic function is associated with higher glucose levels [3, 19, 21]. Chronic increase in plasma glucose levels has been shown to negatively influence LV diastolic performance through different mechanisms, including alteration in mitochondrial energy metabolism and increment in myocardial oxidative stress [10, 11], LV mass increase and changes in myocardial composition [7, 8], acceleration of large artery stiffening and consequent increase in vascular load [12–14].…”

Section: Discussionmentioning

confidence: 99%

“…If the deficit of observed e′ value to the age-related normal e′ value was greater than the lower 95% tolerance interval, the subject was considered having diastolic dysfunction [20]. …”

Section: Methodsmentioning

confidence: 99%

“…In addition, e′ velocity has been shown to be inversely related to serum concentration of procollagen type I carboxy-terminal propeptide [17], which is considered a marker of myocardial collagen content [18]. Previous studies have reported reduced e′ velocity of mitral annulus in asymptomatic T2DM patients [19, 20] as well as an association between e′ velocity and poor glycemic control [19, 21]. They have also demonstrated an inverse relationship between e′ velocity and LV mass or arterial stiffness [22, 23] and a direct association between diastolic e′ and systolic s′ longitudinal velocities [23].…”

Section: Introductionmentioning

confidence: 99%

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Impact of glycemic control on aortic stiffness, left ventricular mass and diastolic longitudinal function in type 2 diabetes mellitus

Kozàkovà

Morizzo

Fraser

et al. 2017

Cardiovasc Diabetol

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BackgroundPoor glycemic control is associated with impaired left ventricular (LV) diastolic function in patients with type 2 diabetes mellitus (T2DM). Inappropriate LV mass increase and accelerated aortic stiffening were suggested to participate on deterioration of diastolic function. The present study investigated the inter-relationships between glycemic control, early diastolic and systolic longitudinal velocity of mitral annulus, LV mass and aortic stiffness in T2DM patients free of cardiovascular disease and with preserved LV ejection fraction, and compared them with those observed in healthy volunteers of similar age and sex distribution.Methods125 T2DM patients and 101 healthy volunteers underwent noninvasive measurement of systolic (s′) and early diastolic (e′) velocities of mitral annulus, LV mass, carotid-femoral pulse wave velocity (cfPWV) and local carotid blood pressure (BP).ResultsForty-four (35.2%) T2DM patients had e′ velocity lower than that expected for age (against 7.9% in healthy volunteers; P < 0.0001), 34 (27.2%) had cfPWV higher than that expected for age and mean BP (against 5.9% in healthy volunteers; P < 0.0001), and 71 (56.8%) had LV mass higher than that expected for body size and stroke work (against 17.6% in healthy volunteers; P < 0.0001). Carotid systolic BP was higher in T2DM patients (124 ± 14 vs 111 ± 11 mmHg; P < 0.0001). In multivariate analysis, e′ velocity was independently related to age, carotid BP and s′ velocity in healthy volunteers, and to male sex, age, carotid BP, heart rate and LV mass in T2DM. Glycosylated hemoglobin (HbA1c) was independently related to cfPWV and LV mass in T2DM patients. T2DM patients with HbA1c ≥6.5% (N = 85) had higher cfPWV (P < 0.05), central BP (P = 0.01), prevalence of LV hypertrophy (P = 0.01) and lower e′ and s′ velocity (P = 0.001 and <0.05, respectively) as compared to those with HbA1c <6.5%.ConclusionsOne-third of T2DM patients with preserved LV ejection fraction has sign of subclinical LV diastolic dysfunction. HbA1c levels are positively associated with LV mass and aortic stiffness, both of which show a negative independent impact on early diastolic velocity e′, the latter through an increase in afterload. T2DM patients with suboptimal glycemic control (HbA1c ≥ 6.5%) have lower diastolic and systolic LV longitudinal performance, together with increased aortic stiffness and a higher prevalence of LV hypertrophy.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Impact of glycemic control on aortic stiffness, left ventricular mass and diastolic longitudinal function in type 2 diabetes mellitus

Kozàkovà

Morizzo

Fraser

et al. 2017

Cardiovasc Diabetol

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“…It is determined by a delayed and extended diastolic phase, with impaired early diastolic filling, prolongation of isovolumetric relaxation, increased atrial filling and increased myocardial stiffness, predominantly in late diastole [28, 42-43]. Electrophysiologically, diastolic dysfunction is characterized by the prolongation of the active dilatation and the augmented passive stiffness of the left ventricle, which portray the passive diastolic LV compliance in heart failure [44].…”

Section: Cardiac Preclinical Damagementioning

confidence: 99%

Present Insights on Cardiomyopathy in Diabetic Patients

Felício

Koury²,

Carvalho³

et al. 2016

CDR

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The pathogenesis of diabetic cardiomyopathy (DCM) is partially understood and is likely to be multifactorial, involving metabolic disturbances, hypertension and cardiovascular autonomic neuropathy (CAN). Therefore, an important need remains to further delineate the basic mechanisms of diabetic cardiomyopathy and to apply them to daily clinical practice. We attempt to detail some of these underlying mechanisms, focusing in the clinical features and management. The novelty of this review is the role of CAN and reduction of blood pressure descent during sleep in the development of DCM. Evidence has suggested that CAN might precede left ventricular hypertrophy and diastolic dysfunction in normotensive patients with type 2 diabetes, serving as an early marker for the evaluation of preclinical cardiac abnormalities. Additionally, a prospective study demonstrated that an elevation of nocturnal systolic blood pressure and a loss of nocturnal blood pressure fall might precede the onset of abnormal albuminuria and cardiovascular events in hypertensive normoalbuminuric patients with type 2 diabetes. Therefore, existing microalbuminuria could imply the presence of myocardium abnormalities. Considering that DCM could be asymptomatic for a long period and progress to irreversible cardiac damage, early recognition and treatment of the preclinical cardiac abnormalities are essential to avoid severe cardiovascular outcomes. In this sense, we recommend that all type 2 diabetic patients, especially those with microalbuminuria, should be regularly submitted to CAN tests, Ambulatory Blood Pressure Monitoring and echocardiography, and treated for any abnormalities in these tests in the attempt of reducing cardiovascular morbidity and mortality.

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Impaired left ventricular diastolic function in T2DM patients is closely related to glycemic control

Clarke

Molina‐Wilkins

Solis‐Herrera

et al. 2018

Endocrino Diabet & Metabol

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Summary Background Left ventricular (LV) diastolic dysfunction commonly is observed in individuals with type 2 diabetes mellitus (T2DM). We employed transthoracic echocardiography (TTE) and cardiac magnetic resonance imaging (CMRI) to investigate the hypothesis that LV diastolic dysfunction in T2DM is associated with poor glycemic control. Methods Forty subjects, 21 with normal glucose tolerance (NGT) and 19 with T2DM, were studied with CMRI and TTE to assess LV function. Early‐to‐late transmitral flow ratio (E/A) and deceleration time (DecT) were assessed with both modalities. Normalized (to body surface area) end‐diastolic volume (EDV/BSA) and normalized peak LV filling rate (pLVFR/BSA) were assessed with CMRI. Early transmitral flow velocity to septal velocity (E/e’) and isovolumetric relaxation time (IVRT) were measured using TTE. Dimensional parameters were normalized to body surface area (BSA). Results CMRI measurements demonstrated impaired E/A (1.13 ± 0.34 vs 1.62 ± 0.42, P < .001), increased DecT (174 ± 46 ms vs 146 ± 15, P = .005), as well as lower EDV/BSA (63 ± 10 vs 72 ± 9 mL/m2, P < .01) and pLVFR/BSA (189 ± 46 vs 221 ± 48 mL s−1 m−2, P < .05) in T2DM subjects. TTE measurements revealed lower E/A (1.1 ± 0.4 vs 1.4 ± 0.2, P < .001) and E/e’ (6.8 ± 1.5 vs 8.7 ± 2.0, P < .0001) with higher DecT (203 ± 22 ms vs 179 ± 18, P < .001) and IVRT (106 ± 14 ms vs 92 ± 10, P < .001) in T2DM. Multiple parameters of LV function: E/ACMRI (r = −.50, P = .001), E/ATTE (r = −.46, P < .005), pLVFR/BSA (r = −.35, P < .05), E/e’ (r = −.46, P < .005), EDV/BSACMRI (r = −.51, P < .0001), EDV/BSATTE (r = −.42, P < .01) were negatively correlated with HbA1c. All but E/e’ also were inversely correlated with fasting plasma glucose (FPG). Conclusions Impaired LV diastolic function (DF) was found in T2DM subjects with both CMRI and TTE, and multiple LVDF parameters correlated negatively with HbA1c and FPG. These results indicate that impaired LVDF is inversely linked to glycemic control in T2DM patients.

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Quantification of diastolic dysfunction via the age dependence of diastolic function — Impact of insulin resistance with and without type 2 diabetes

Abstract: The physiological impact of age on myocardial function consists of a 1% annual reduction in E' and enables precise quantification of diastolic dysfunction thereby unmasking the importance of metabolic risk for DDF.

Cited by 34 publications

References 30 publications

Impact of glycemic control on aortic stiffness, left ventricular mass and diastolic longitudinal function in type 2 diabetes mellitus

Impact of glycemic control on aortic stiffness, left ventricular mass and diastolic longitudinal function in type 2 diabetes mellitus

Present Insights on Cardiomyopathy in Diabetic Patients

Impaired left ventricular diastolic function in T2DM patients is closely related to glycemic control

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