Asymptomatic diabetic cardiomyopathy: a noninvasive study

Attali, J. R.; Sachs, R. N.; Valensi, P.; Palsky, D.; Tellier, Philippe; Vulpillat, M.; Lanfranchi, J; Sébaoun, J

doi:10.1016/s0168-8227(88)80016-0

Cited by 41 publications

(17 citation statements)

References 26 publications

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“…41 Evidence from clinical and autopsy studies supports the observation that silent manifestations of IHD are more prevalent in persons with than without NIDDM.6-8,42,43 Three prospective population-based studies have found a higher incidence of unrecognized myocardial infarction (defined by major Q waves on resting ECG) in persons with diabetes as compared with those without diabetes although the differences were not statistically significant.36,37'44 '45 The mechanisms underlying painless manifestations of IHD remain unclear.46 In diabetics, decreased cardiac pain perception (as a result of autonomic neuropathy) has been suggested by others and would be compatible with the absence of a significant increase in angina pectoris and resting electrocardiographic abnormalities accompanied by symptoms among persons with NIDDM in this population.7'43'46 Part of the excess of electrocardiographic abnormalities in the absence of symptoms could reflect diabetic cardiomyopathy, the nature of which (atherosclerotic or nonatherosclerotic) remains controversial. 47,48 Recent clinical studies have characterized pathophysiological differences between silent and painful episodes of myocardial ischemia and raised the question whether silent ischemia indicates a functional component of atherosclerotic heart disease, apart from just morphological stenosis of the coronary arteries. 29,46 In this regard, it is interesting that systolic blood pressure but not lipoproteins showed a consistent independent relation with resting electrocardiographic abnormalities suggestive of asymptomatic IHD in this study, as with unrecognized myocardial infarction in previous reports.36'4449 Several previous studies have observed a strong positive association between blood pressure and diabetes mellitus or asymptomatic hyperglycemia but the pathophysiological basis of this coincidence is not completely understood.2'50 There is evidence that cardiac mortality in diabetics increases in the presence of hypertension.47 Whether this might, in part, be because of a synergistic effect of blood pressure and diabetic status on the development of silent IHD deserves further investigation.…”

Section: Relation Of Electrocardiographic Changes With and Without Symentioning

confidence: 99%

Resting electrocardiographic abnormalities suggestive of asymptomatic ischemic heart disease associated with non-insulin-dependent diabetes mellitus in a defined population.

1990

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The prevalence of ischemic heart disease (IHD) in older adults by glucose tolerance status was evaluated in 2,223 white men and women, aged 50-89 years, in the Rancho Bernardo cohort who were studied between 1984 and 1987. Impaired glucose tolerance (IGT) and noninsulin-dependent diabetes mellitus (NIDDM) were classified according to World Health Organization criteria. End points of ischemic heart disease were defined by Rose Questionnaire and resting electrocardiogram (ECG) according to the Minnesota Code. IHD by electrocardiographic changes was classified as asymptomatic (without history of chest pain or overt IHD) or symptomatic (with history). IHD by all criteria combined was significantly more common in men and women with NIDDM, and in women with IGT, than in those with normal glucose tolerance. The prevalence of myocardial infarction, defined by major Q wave, Rose Questionnaire chest pain criteria, or personal history, was higher in persons with NIDDM than in persons without; the difference was highly significant in women (odds ratio, 2.08 [1.22, 3.56]; p=0.09). Angina pectoris was not significantly related to NIDDM or IGT in either sex. Electrocardiographic evidence of asymptomatic IHD was significantly more prevalent in both men and women with NIDDM as compared with those with normal glucose tolerance (odds ratios, 1.75 [1.10, 2.81] for men and 1.80 [1.07, 3.01] for women; p<0.05). This significant association persisted after excluding persons on digitalis or diuretic therapy and, in women, was also independent of the effect of major known IHD risk factors. These population-based data are consistent with clinical reports suggesting an association of diabetes with silent myocardial infarction or ischemia. The presence of ischemic resting electrocardiographic abnormalities in the asymptomatic diabetic patient is likely to have prognostic and therapeutic implications. (Circulation 1990;81:899-906) Over the past 25 years, an excess risk of ischemic heart disease (IHD) morbidity and mortality has been observed consistently in diabetics of Western societies despite variable study designs and changing diagnostic criteria.1,2 Very few population-based studies have considered both standardized criteria for nonfatal IHD end points and current criteria for non-insulin-dependent diabetes mellitus (NIDDM) and impaired glucose tolerance (IGT).3-5Data are particularly scarce regarding the association of diabetes with painless (silent) myocardial infarction or ischemia although clinical studies have drawn attention to this coincidence.6-8 We report, here, the prevalence of All editorial decisions for this article, including selection of reviewers and the final decision, were made by a guest editor. This procedure applies to all manuscripts with authors from the University of California San Diego or

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Section: Relation Of Electrocardiographic Changes With and Without Symentioning

confidence: 99%

Resting electrocardiographic abnormalities suggestive of asymptomatic ischemic heart disease associated with non-insulin-dependent diabetes mellitus in a defined population.

1990

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“…Numerous studies have reported normal LV systolic function at rest in most type 1 diabetic patients (4), whereas others have suggested increased LV systolic function (5,6). Several investigators have shown abnormal LV diastolic function in the majority of type 1 diabetic patients (7)(8)(9)(10)(11), whereas others (12) found no evidence of LV diastolic dysfunction at rest in longterm type 1 diabetic patients. It has been suggested that LV dysfunction in type 1 diabetic patients may be related to structural changes of the myocardium or to concomitant diabetic autonomic neuropathy (DAN) (13).…”

mentioning

confidence: 99%

Left Ventricular Systolic and Diastolic Function in Normotensive Type 1 Diabetic Patients With or Without Autonomic Neuropathy

Didangelos

Arsos²,

Karamitsos³

et al. 2003

Diabetes Care

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OBJECTIVE -To investigate the relation between diabetic autonomic neuropathy (DAN) and left ventricular (LV) function in type 1 diabetic patients. RESEARCH DESIGN AND METHODS-A total of 57 type 1 diabetic patients free of coronary artery disease and arterial hypertension were studied. Diagnosis of DAN was established by autonomic nervous function (ANF) tests, and LV systolic and diastolic functions were assessed by radionuclide ventriculography at rest.RESULTS -There were 24 patients who had definite DAN, established by the presence of two or more abnormal ANF tests, and 33 subjects were without DAN. DAN patients had impaired LV filling pattern, obvious by a reduced peak filling rate (3.1 Ϯ 1.1 vs. 3.7 Ϯ 0.7 end-diastolic volume [EDV]/s, P ϭ 0.011) and first third filling fraction (35.3 Ϯ 19.5 vs. 50.8 Ϯ 16%, P ϭ 0.002) as well as an increased time to peak filling (159.4 Ϯ 45.1 vs. 134.2 Ϯ 33.4 ms, P ϭ 0.02) after correction for age and heart rate. There were no differences between the two groups with regard to ejection fraction, cardiac output, and cardiac index, whereas the peak emptying rate was greater in DAN patients (4.1 Ϯ 0.8 vs. 3.6 Ϯ 0.8 EDV/s, P ϭ 0.019), suggesting LV hypercontractility. DAN patients had an increased heart rate (83.4 Ϯ 11.9 vs. 72.7 Ϯ 9.3 bpm, P ϭ 0.001) and slightly higher systolic blood pressure. As a result, LV working load at rest was higher in DAN patients (11,109 vs. 9,096 bpm ϫ mmHg, P Ͻ 0.001). Moreover, a correlation was found between abnormal LV systolic and diastolic indexes and the number of abnormal ANF tests.CONCLUSIONS -At rest, DAN patients have impaired LV filling pattern, slightly increased LV systolic function, and a higher LV working load, in comparison to non-DAN type 1 diabetic patients. Diabetes Care 26:1955-1960, 2003C linical and epidemiological studies have confirmed that patients with diabetes appear susceptible to heart failure, which is the leading cause of death in these patients (1). Impairment of left ventricular (LV) function is frequent in patients with type 1 diabetes, even in the absence of ischemic, hypertensive, or valvular heart disease (2). Possible mechanisms for a specific diabetic cardiomyopathy include abnormalities of small intramural coronary vessels, deposition of collagen, and lipids and metabolic derangements that alter actomyosin and myosin adenosine triphosphatase activities (3). Although histopathologic and biochemical evidence for a distinct diabetic cardiomyopathy is available, it remains unclear whether these pathologic processes may cause significant LV systolic or diastolic dysfunction. Numerous studies have reported normal LV systolic function at rest in most type 1 diabetic patients (4), whereas others have suggested increased LV systolic function (5,6). Several investigators have shown abnormal LV diastolic function in the majority of type 1 diabetic patients (7-11), whereas others (12) found no evidence of LV diastolic dysfunction at rest in longterm type 1 diabetic patients. It has been suggested that LV dysfunction in type...

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“…This was because, as the duration of diabetes increased, other associated comorbid diseases like hypertension, IHD, were also present which were excluded in our study, so the patients with duration of diabetes more than 15 years and above age of 70 years were less. In a study done by Attali et al 12 it was observed that LV diastolic dysfunction was present in patients who were free of cardio vascular disease, had diabetes of less than 5 years.…”

Section: Discussionmentioning

confidence: 97%

Echocardiographic Evaluation of Diastolic Dysfunction in Asymptomatic Type 2 Diabetes Mellitus

Chandravanshi¹,

Jain²,

Gupta³

2015

jemds

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Diabetes mellitus is one of the most common diseases in the world and is acquiring epidemic proportions. Its prevalence is growing in both developed and developing countries. India is the Diabetic Capital Of the world. Indians are genetically more susceptible to diabetes compared to other races. Cardiovascular complications are known to be the main cause of morbidity and death in diabetic patients. In diabetic patients there is an increased rate of ischemic heart disease and cardiomyopathy which may lead to heart failure (Diastolic heart failure). Despite similar left ventricular systolic function, patients with diabetes have more pronounced heart failure symptoms, use more diuretics, and have an adverse prognosis compared with those without diabetes; one putative explanation for these discrepancies is diastolic dysfunction of the left ventricle in diabetes mellitus. Left ventricular diastolic dysfunction represents an early stage of heart failure, without any clinical manifestations. In the view of these above facts the present study was conducted to assess the diastolic dysfunction in diabetic patients. MATERIAL AND METHODS: This cross sectional study comprising 50 cases was conducted in the Department of Medicine, Pt. Jawaharlal Nehru Memorial Medical College and Dr. B.R.A.M. Hospital, Raipur (C.G.) from July 2013 to July 2014 in diabetic patients without evidence of cardiovascular involvement and blood pressure less than 140/90mmHg were studied. Permission of ethical committee was taken. 26 patients were female and 24 were male. LVDD was evaluated by Doppler echocardiography, which included E/A ratio; left atrial size was assessed in relation with age/sex, duration of diabetes and HbA1c level. RESULTS: Results showed that diastolic dysfunction was present in 35 (70 %) of the patients. Among males diastolic dysfunction was present in 17 cases (70.83%). Among females diastolic dysfunction was present in 18 cases (69.23%). Diastolic dysfunction was associated with uncontrolled diabetes as assessed by HbA1c levels. Diastolic dysfunction was more common in patients who were on treatment with both oral hypoglycemic agents and insulin. The prevalence of diastolic dysfunction increased with longer duration of diabetes. There was a linear progression of diastolic dysfunction with the increase in age and those with more Left Atrial size. CONCLUSION: The findings in our study indicate that myocardial damage in patients with diabetes affects left ventricular diastolic function before systolic function. E/A ratio and Left atrial size are significantly altered in diabetic patients with diastolic dysfunction. Diastolic dysfunction is significantly associated with duration of diabetes, glycemic levels and the type of treatments. Onset of diastolic dysfunction occurs earlier in females as compared to males. Doppler Echocardiography is a simple, noninvasive, cheap, easily available and a valuable tool in diagnosing diastolic dysfunction. In diabetics before they develop cardiac symptoms, Echocardiography should be d...

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Asymptomatic diabetic cardiomyopathy: a noninvasive study

Cited by 41 publications

References 26 publications

Resting electrocardiographic abnormalities suggestive of asymptomatic ischemic heart disease associated with non-insulin-dependent diabetes mellitus in a defined population.

Resting electrocardiographic abnormalities suggestive of asymptomatic ischemic heart disease associated with non-insulin-dependent diabetes mellitus in a defined population.

Left Ventricular Systolic and Diastolic Function in Normotensive Type 1 Diabetic Patients With or Without Autonomic Neuropathy

Echocardiographic Evaluation of Diastolic Dysfunction in Asymptomatic Type 2 Diabetes Mellitus

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