Cats with diabetes mellitus have diastolic dysfunction in the absence of structural heart disease

Abstract

Diabetes mellitus (DM) can result in cardiovascular dysfunction and heart failure characterized by diastolic dysfunction with or without the presence of systolic dysfunction in people and laboratory animals. The objective of this prospective study was to determine if cats with newly diagnosed DM had myocardial dysfunction and, if present, whether it would progress if appropriate antidiabetic therapy was commenced. Thirty-two diabetic cats were enrolled and received baseline echocardiographic examination; of these, 15 cats were re-examined after 6 months. Ten healthy age- and weight-matched cats served as controls. Diabetic cats at diagnosis showed decreased diastolic, but not systolic function, when compared to healthy controls, with lower mitral inflow E wave (E) and E/E' than controls. After 6 months, E and E/IVRT' decreased further in diabetic cats compared to the baseline evaluation. After excluding cats whose DM was in remission at 6 months, insulin-dependent diabetic cats had lower E, E/A and E' than controls. When classifying diastolic function according to E/A and E'/A', there was shift towards impaired relaxation patterns at 6 months. All insulin-dependent diabetic cats at 6 months had abnormal diastolic function. These results indicate that DM has similar effects on diastolic function in feline and human diabetics. The dysfunction seemed to progress rather than to normalize after 6 months, despite antidiabetic therapy. In cats with pre-existing heart disease, the development of DM could represent an important additional health risk.

Associations among echocardiography, cardiac biomarkers, insulin metabolism, morphology, and inflammation in cats with asymptomatic hypertrophic cardiomyopathy

“…Existence of a comparable cardiomyopathy related to hyperinsulinemia in cats remains controversial. Although diastolic dysfunction and increased risk of heart failure have been observed in diabetic cats, maximum left ventricular wall thickness was not significantly different in a study comparing diabetic and healthy cats . The effects of insulin and IGF‐1 are strongly related, because insulin and IGF‐1 fully activate their own receptors, and also, although with decreased affinity, bind and activate the other receptor .…”

“…Existence of a comparable cardiomyopathy related to hyperinsulinemia in cats remains controversial. Although diastolic dysfunction29 and increased risk of T A B L E 4 Significant associations between variables from different parts of the hypothesized mechanism 0.29, P = .04) IGF-1 (r = 0.44, P = .001) BCS Insulin (ρ = 0.33, P = .02) Glucose (ρ =0.29, P = .04) IGF-1 (ρ = 0.32, P = .02) IVSd Max-IVSd (ρ = 0.32, P = .05) n-IVSd (ρ = 0.28, P = .05) LVWd Max-LVWd (ρ = 0.41, P = .01) LA LA/Ao (ρ = 0.52, P = .001) LAmax (ρ = 0.32, P = .05) LA remodeling (ρ = 0.38, P = .02) LA/Ao (ρ = 0.49, P = .001) LAmax (ρ = 0.28, P = .05) LA remodeling (ρ = 0.38, P = .01) Abbreviations: BCS, body condition score; BW, body weight; cTnI, cardiac troponin-I; IGF-1, insulin-like growth factor-1; LA/Ao, left atrium to aorta ratio; LA-max, maximum diameter of left atrium; Max-IVSd, maximum thickness of interventricular septum in diastole; Max-LVWd, maximum thickness of left ventricular free wall in diastole; n-IVSd, number of regions in interventricular septum in diastole ≥6 mm; n-LVWd, number of regions of left ventricular free wall in diastole ≥6 mm; SAA, serum amyloid A.…”

Time spent with cats is never wasted: Lessons learned from feline acromegalic cardiomyopathy, a naturally occurring animal model of the human disease

“…Although diabetes causes LV hypertrophy in humans [ 41 , 42 ], the cardiovascular effect of diabetes in cats is poorly understood. One retrospective case series did report a greater prevalence of cardiac disease in diabetic cats than age-matched controls [ 43 ], whilst another study evaluating serial echocardiographic changes in cats with DM suggested that diastolic dysfunction was associated with the diabetic state [ 44 ]. No studies investigating the potential pro-hypertrophic effect of DM in cats have been published.…”

Necropsy findings in a cat with diabetes mellitus and heart failure

“…Another study sought to assess cardiac function in feline patients with newly diagnosed DM and to characterise any development over the course of 6 months. 11 This showed that cats with DM had evidence of diastolic, but not systolic, dysfunction, in the absence of structural heart disease and when compared with healthy controls. This study excluded cats with primary heart disease as far as possible, including those with evidence of HCM on echocardiography; however, there was no histopathological assessment of these cases.…”