Influence of acute hyperglycemia on left ventricular function in diabetics assessed by echocardiography

Abstract

Summary: Myocardial dysfunction in diabetes mellitusis reversed by proper correction of metabolic changes. To assess the role of hyperglycemia on cardiac dysfunction, 50 g of dextrose were intravenously infused to 15 subjects with stable type 2 diabetes. Echocardiographic measurements were made at 0,60, 120, 180, and 240 minutes. In spite of the high levels of blood glucose reached in diabetics, left ventricular ejection fraction, fractional shortening, and stroke volume did not experience significant changes. Moreover, cardiac output significantly (p ~0 . 0 1 ) increased in diabetics secondary to an increase in heart rate. No cardiac changes were noticed in 7 healthy subjects studied in a similar fashion. However, their induced hyperglycemia was not as elevated as in the diabetic patients. These results suggest that acute induced hyperglycemia per se does not appear to impair left ventricular contractility in diabetics at resting conditions.

Effect of Acute Hyperglycemia on Left Ventricular Contractile Function in Diabetic Patients with and without Heart Failure: Two Randomized Cross-Over Studies

“…A previous study reports that glucose levels acutely increased by glucose infusion in T2D patients with normal LVEF had no effect on global LV function [31]. However, in the present studies more sensitive measurements based on tissue-Doppler velocity unambiguously demonstrated that left ventricular contractile function was higher during hyperglycemia than during normoglycemia.…”

Impact of acute hyperglycemia on layer-specific left ventricular strain in asymptomatic diabetic patients: an analysis based on two-dimensional speckle tracking echocardiography

“…Some of the previously conducted studies have shown that hyperglycemia following a glucose infusion in diabetic patients with normal LVEF, had no effect on the global LV function [43] detected by standard echocardiography, while we used more sophisticated method (strain analysis) for detection of LV systolic function. Studies in animal models indicated that acute hyperglycemia could suppress LV diastolic function and influences mitochondrial energy signaling [44], or induces changes in polyol metabolic pathway with consequently increase in oxidative stress leading to myocardial contractile dysfunction [45].…”

Acute changes in plasma glucose increases left ventricular systolic function in insulin‐treated patients with type 2 diabetes and controls

“…In a previous study in patients with T2D and healthy controls, 50 g dextrose intravenous infusion increasing PG to 27 mmol/L in the patients with T2D did not have a significant effect on LVEF. 4 However, the statistical method applied (comparing absolute means instead of change from baseline) may have masked an effect, and mean LVEF did rise from 63% to 66%, whereas it was unchanged in controls, in whom PG remained <10 mmol/L. In patients with type 1 diabetes (T1D), acute normalization of PG leads to a decline in LVEF, whereas normalization of long-term glycaemic control as evaluated by HbA1c had no effect on LVEF.…”

“…Hence, hyperglycaemia with abundant glucose availability and enhanced endogenous insulin production may promote glucose utilization, potentially enhancing cardiac function. An improved systolic function during hyperglycaemia in patients with T2D has been indicated in previous studies, although no effect on left ventricular ejection fraction (LVEF) was observed, and consequently the practical implications are uncertain 3,4 …”

“…An improved systolic function during hyperglycaemia in patients with T2D has been indicated in previous studies, although no effect on left ventricular ejection fraction (LVEF) was observed, and consequently the practical implications are uncertain. 3,4 Acute hypoglycaemia has previously been demonstrated to markedly increase LVEF as measured by radionuclide ventriculography in healthy young males due to a substantial sympathoadrenal response. 5 A detailed description of changes in cardiac function during hypoglycaemia in an insulin-treated T2D population with high risk of hypoglycaemia has not previously been performed.…”