Left Ventricular Diastolic Filling in Diabetes Mellitus With and Without Hypertension

Abstract

Left ventricular diastolic filling by Doppler echocardiography was investigated in 84 diabetic patients without evidence of heart disease and in 84 normotensive nondiabetic age- and sex-matched control subjects. Diabetic patients were subdivided into two groups on the basis of the presence of arterial hypertension. Group 1 comprised 41 normotensive diabetic patients (19 men, 22 women, mean age 63.7 +/- 9.1 years); Group 2 comprised 43 hypertensive diabetics (15 men, 28 women, mean age 65.6 +/- 9.6 years). Doppler measures of diastolic filling were significantly altered in the two groups as compared with control subjects. Peak atrial flow velocity, velocity integral for the atrial filling period, and atrial filling fraction were increased, whereas the ratio of peak early to peak atrial flow velocity and the ratio of flow velocity integrals were decreased, especially in Group 2 patients. Thirteen patients in Group 1 (32%) and 17 in Group 2 (40%) had evidence of diastolic dysfunction, as assessed by the presence of at least two independent abnormal indices (outside age-corrected 95% confidence interval). In each group, patients with altered diastolic filling differed slightly from diabetic patients with normal Doppler indices, tending to increased wall thickness and left ventricular mass. In conclusion, diastolic filling of the left ventricle is frequently altered in diabetic patients and is adversely affected by arterial hypertension whose coexistence further impairs left ventricular relaxation.

Fasting Plasma Glucose Is an Independent Determinant of Left Ventricular Diastolic Dysfunction in Nondiabetic Patients with Treated Essential Hypertension.

“…Many studies have reported that diabetes mellitus and hypertension additively augment LV hypertrophy and diastolic dysfunction (8,9,(17)(18)(19)(20)(21). Two of these studies reported that diabetic hypertensives had greater LVMI and more abnormalities in LV relaxation (decrease in E/A and prolongation of the deceleration time) than did nondiabetic hypertensives (8,9).…”

Abnormal echocardiography in patients with type 2 diabetes and relation to symptoms and clinical characteristics

“…4,6,7 In addition, because of advancing age and comorbidities, including hypertension and obesity, patients with type 2 diabetes are also prone to other cardiac pathologies affecting prognosis including but not limited to left ventricular hypertrophy, 8,9 reduced left and right ventricular ejection fraction, 10 dilated left atrium 11 or valve disorders. 12 However, previous reports on prevalence of echocardiographic findings were based on populations that were Abnormal echocardiography in patients with type 2 diabetes and relation to symptoms and clinical characteristics either small 6,7,13,14 from the primary care setting/general population 4,15,16 or included patients before the era of modern multifactorial treatment. 17 Even more, contemporary, intensive treatment of hypertension, hyperglycaemia, dyslipidemia and lifestyle factors 18 may have changed the risk profile for having echocardiographic abnormalities making it difficult to choose which patients to refer to echocardiography.…”

Rodent models of diabetic cardiomyopathy

“…This has led to the use of the term 'diabetic cardiomyopathy' , which has been defined as ventricular dysfunction occurring in diabetic patients in the absence of coronary artery disease and hypertension (Regan et al, 1977;Fein, 1990). The term now includes diabetic individuals with diastolic dysfunction, the prevalence of which may be as high as 60% in well-controlled type 2 diabetic patients (Nicolino et al, 1995;Di Bonito et al, 1996;Poirier et al, 2001;Schannwell et al, 2002;Bell, 2003;Di Bonito et al, 2005).…”