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

Fiorina, Paolo; Rocca, E. La; Astorri, E; Lucignani, Giovanni; Rossetti, Claudio; Fazio, Ferruccio; Giudici, D.; Carlo, V. Di; Cristallo, M.; Pozza, G.; Secchi, Antonio

doi:10.2337/diacare.23.12.1804

Cited by 80 publications

(38 citation statements)

References 30 publications

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“…The more important finding of this study is that insulin treatment has a positive effect on LV diastolic function, confirmed directly by animal data [18] and indirectly by kidney-pancreas transplantation in humans [19]. The beneficial effect of insulin treatment on diastolic function is possibly related to maintaining a more normal metabolic milieu and prevention of further myocardial structural change or fibrosis.…”

Section: Discussionsupporting

confidence: 66%

Determinants of subclinical diabetic heart disease

et al. 2005

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Aims/hypothesis: Subclinical left ventricular (LV) dysfunction has been shown by tissue Doppler and strain imaging in diabetic patients in the absence of coronary disease or LV hypertrophy, but the prevalence and aetiology of this finding remain unclear. This study sought to identify the prevalence and the determinants of subclinical diabetic heart disease. Methods: A group of 219 unselected patients with type 2 diabetes without known cardiac disease underwent resting and stress echocardiography. After exclusion of coronary artery disease or LV hypertrophy, the remaining 120 patients (age 57±10 years, 73 male) were studied with tissue Doppler imaging. Peak systolic strain of each wall and systolic (Sm) and diastolic (Em) velocity of each basal segment were measured from the three apical views and averaged for each patient. Significant subclinical LV dysfunction was identified according to Sm and Em normal ranges adjusted by age and sex. Strain and Em were correlated with clinical, therapeutic, echocardiographic and biochemical variables, and significant independent associations were sought using a multiple linear regression model. Results: Significant subclinical LV dysfunction was present in 27% diabetic patients. Myocardial systolic dysfunction by peak strain was independently associated with glycosylated haemoglobin level (p<0.001) and lack of angiotensin-converting enzyme inhibitor treatment (p=0.003). Myocardial diastolic function (Em) was independently predicted by age (p=0.013), hypertension (p=0.001), insulin (p=0.008) and metformin (p=0.01) treatment. Conclusions/interpretation: In patients with diabetes mellitus, subclinical LV dysfunction is common and associated with poor diabetic control, advancing age, hypertension and metformin treatment; ACE inhibitor and insulin therapies appear to be protective.

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Section: Discussionsupporting

confidence: 66%

Determinants of subclinical diabetic heart disease

et al. 2005

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“…However, Poirier and colleagues did not find any difference in the glycemic indices and concluded that fasting blood glucose levels did not correlate with the presence of diastolic dysfunction in type 2 diabetes (Gaash, 1991). This was in accordance with Fiorina, who demonstrated that glycemic levels had an impact on diastolic dysfunction (Fiorina, 2000). There was one study done by Ann m. Grandi et al, showed a close relationship between glycemic control and left ventricular diastolic dysfunction in 36 type 1 diabetic patients, which improved with glycemic control (Grandi, 2006).…”

Section: Discussionsupporting

confidence: 68%

Asymptomatic Left Ventricular Diastolic Dysfunction in Niddm; Evaluation and Association with Glycemic Control

Kashif¹,

Ali²,

Hakim³

et al. 2016

Int. j. endorsing health sci. res.

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DM is an established risk factor for congestive cardiac failure, in which the diastolic function is impaired. The majority of these patients may be asymptomatic without signs of overt heart failure. The aim of this study was to determine asymptomatic Left Ventricular Diastolic Dysfuction (LVDD) in Non-Insulin Dependent Diabetes Mellitus (NIDDM) in association with glycemic control and to assess the risk factors for the development of diastolic dysfunction. This cross sectional study was conducted at the Tabba Heart Institute, Karachi from Dec, 2011 to Nov 2012, 101 asymptomatic patients with type 2 diabetes without evidence of cardio-respiratory illness were enrolled. LVDD was evaluated by Doppler echocardiography, which included the valsalva manoeuvre. A total of 101 patients, LVDD was found in 67 subjects (66.34%) of whom 52 (51.48%) had impaired relaxation and 15 (14.85%) had a pseudonormal pattern of ventricular filling. The potential risk factors for the development of LVDD in type 2 diabetics were (a) age ≥45 years was associated with an almost three times higher risk for LVDD, (b) females had almost two times a higher risk of LVDD as compared with men, and (c) Diabetic patients of more than two years' duration had a two times higher risk of LVDD. The study results also indicate that LVDD was significantly associated with increased age, longer duration of Diabetes and glycemic control (glycated HbA1c levels) and LVDD is found in diabetic patients before the onset of clinically detectable disease. The high prevalence of LVDD suggests that screening for LVDD should include procedures such as the valsalva manoeuvre.

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“…shown a direct relationship between the extent of diastolic dysfunction and glycemic control (68) (Figure 6). Consistent with this, studies that have examined the effects of improved metabolic control with pancreas transplantation noted reversal of diastolic abnormalities in recipients of a combined kidneypancreas transplant over a 4-yr period but not in patients with kidney transplantation alone (69).…”

Section: Tissue Doppler Imagingmentioning

confidence: 65%

Heart Failure and Nephropathy

Gilbert

Connelly

Kelly

et al. 2006

Clinical Journal of the American Society of Nephrology

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Heart failure (HF) is a major contributor to poor quality of life, a leading cause of hospitalization, and cause of premature death. Both kidney disease and diabetes are major and independent risk factors for the development of heart failure, such that individuals with diabetic nephropathy are at especially high risk. Such patients not only are likely to have coronary artery disease and hypertension but also are likely to have diabetic cardiomyopathy, a distinct pathologic entity that is more closely associated with the microvascular than the macrovascular complications of diabetes. In addition to a better understanding of the epidemiology of HF, advances in noninvasive imaging have highlighted the importance of early cardiac dysfunction in diabetes and the high prevalence of HF with preserved left ventricular systolic function. Although significant renal dysfunction is usually an exclusion criterion in HF trials, diabetes is often a prespecified subgroup so that subanalyses of large multicenter clinical trials do provide some guidance in therapeutic decision-making. However, further therapies for both HF and nephropathy in diabetes clearly are needed, and a number of new therapeutic strategies that target both disorders have already entered the clinical arena.

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

Cited by 80 publications

References 30 publications

Determinants of subclinical diabetic heart disease

Determinants of subclinical diabetic heart disease

Asymptomatic Left Ventricular Diastolic Dysfunction in Niddm; Evaluation and Association with Glycemic Control

Heart Failure and Nephropathy

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