Left Ventricular Diastolic Function in Type 2 Diabetes Mellitus

Abstract

Background-Although type 2 diabetes mellitus is a risk factor for developing congestive heart failure, the mechanism leading to heart failure is unclear. We examined the prevalence of left ventricular (LV) systolic and diastolic dysfunction in patients with type 2 diabetes mellitus in relation to vascular function and myocardial perfusion. Methods and Results-A prospective observational study of 305 patients with type 2 diabetes mellitus (diabetes duration, 4.5Ϯ5.3 years) referred consecutively to a diabetes clinic were screened for LV systolic and diastolic function by echocardiography. Vascular function was estimated using noninvasive estimation of pulse pressure, carotid arterial compliance, total arterial compliance, and valvulo-arterial impedance. The prevalences of LV diastolic dysfunction and left atrial (LA) volume index Ͼ32 mL/m 2 were 40% and 32%, respectively. The prevalence of myocardial ischemia on myocardial perfusion scintigraphy was more frequent in patients with grade 2 diastolic dysfunction and LA volume index Ͼ32 mL/m 2 compared with those having normal or grade 1 diastolic dysfunction (Pϭ0.002) or LA volume index Յ32 mL/m 2 (PϽ0.001), respectively. Predictors of grade 2 diastolic dysfunction and LA dilation were summed stress score on myocardial perfusion scintigraphy, total arterial compliance, and valvulo-arterial impedance, whereas pulse pressure and carotid arterial compliance were not, after adjusting for age, sex, and diabetes duration. On multivariable modeling, summed stress score (PϽ0.001) and valvulo-arterial impedance (Pϭ0.027) remained predictors of grade 2 diastolic dysfunction, and only summed stress score (PϽ0.001) was a predictor of LA dilation. Conclusions-Abnormal LV filling is closely associated with abnormal myocardial perfusion on myocardial perfusion scintigraphy, whereas the association of LV filling with vascular function is less prominent. Clinical Trial Registration-The trial has been registered at www.clinicaltrial.gov with Identifier: NCT00298844.(Circ Cardiovasc Imaging. 2010;3:24-31.)

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

“…6,7,14 This is not restricted to type 2 diabetes, and we have previously reported a high prevalence of diastolic dysfunction in patients with type 1 diabetes without known heart disease, in which similar sex differences were found. 19 In type 2 diabetes, however, small-sized populations have reported considerable variation in the prevalence of diastolic dysfunction, ranging from 40% to 75%.…”

“…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.…”

Fibulin-1 Is a Marker for Arterial Extracellular Matrix Alterations in Type 2 Diabetes

“…We also found associations between plasma fibulin-1 concentrations and signs of myocardial dysfunction, when judged in relation to left atrial volume index and plasma concentrations of NT-proBNP. The most likely cause of variation in left atrium volume in this study is pressure overload caused by abnormal left ventricular relaxation, known to be present in our diabetic population (23 ). This overload may at least partly be caused by increased arterial stiffness, which leads to premature return of reflected pulse waves in late systole (34,37,38 ).…”

“…Echocardiograms were obtained and stored digitally for subsequent blinded analysis as described previously (23 ) and as summarized in the online Supplemental Data file. Similarly, B-mode ultrasound of the carotid artery was performed (24 ) as described in the online Supplemental Data file.…”

Clinical profile of diabetic patients with heart failure admitted in tertiary care teaching hospital, Kishanganj, Bihar- An Observational Study

“…In present study, the prevalence of diastolic dysfunction was 54.33%. Poulsen et al 41 in their prospective observational study of 305 patients with type 2 DM showed that abnormal LV filling is closely associated with abnormal myocardial perfusion on myocardial perfusion scintigraphy.…”