Left ventricular function in patients with type 2 diabetes mellitus

Htay, Thein Thein; Mehta, Deval; Heo, Jaekyeong; Iskandrian, Ami E.

doi:10.1016/j.amjcard.2004.11.043

Cited by 10 publications

(7 citation statements)

References 20 publications

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“…In the last decades, the systolic function in diabetic vs non-diabetic patients has been investigated repeatedly, although mostly in cohorts with much fewer patients and with different LVEF measurement methods; in addition, the results were not conclusive: regarding LVEF, most of the studies did not report a difference between diabetic and non-diabetic patients (23)(24)(25), despite some studies that demonstrated a slightly lower LVEF in diabetic patients (26,27). In the studies in which a lower LVEF was shown, it was mainly attributed to the fact that CAD is more common and also more often severe in diabetic patients even though the presence and extent of CAD were not taken into account (22,(28)(29)(30).…”

Section: Discussionmentioning

confidence: 86%

Diabetes reduces left ventricular ejection fraction-irrespective of presence and extent of coronary artery disease

Ehl¹,

Kühne²,

Brinkert³

et al. 2011

European Journal of Endocrinology

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Background: It is not clear whether diabetes reduces systolic left ventricular function (left ventricular ejection fraction, LVEF) irrespective of coronary artery disease (CAD). The aim of this study was to compare the LVEF between diabetic and non-diabetic patients with respect to the extent of CAD. Methods and results: Consecutive patients undergoing stress myocardial perfusion SPECT (MPS) were evaluated. MPS was interpreted using a 20-segment model with a five-point scale to define summed stress score (SSS), summed rest score, and summed difference score. LVEF was measured by gated SPECT and then compared with respect to diabetic status and SSS categories. Of 2635 patients, data of 2400 was available. Of these, 24% were diabetic, mean age was 64G11y, and 31% were female. Diabetics had a significantly lower LVEF compared with non-diabetics regardless of the extent of CAD: 53G13 and 55G13% respectively (PZ0.001). Diabetics and non-diabetics did not differ significantly in the distribution of SSS categories. Diabetes was an independent predictor of decreased LVEF (odds ratio 1.6, 95% confidence interval 1.2-2.0; P!0.001). Conclusion: Diabetics had a lower LVEF than non-diabetics. This difference could be demonstrated regardless of CAD extent and might in part explain their generally worse cardiac survival compared with non-diabetics on an epidemiological level. In addition, this finding points to discussed mechanisms other than CAD lowering LVEF in diabetics.

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Section: Discussionmentioning

confidence: 86%

Diabetes reduces left ventricular ejection fraction-irrespective of presence and extent of coronary artery disease

Ehl¹,

Kühne²,

Brinkert³

et al. 2011

European Journal of Endocrinology

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Section: Gated Spect For the Evaluation Of Left Ventricular Volumes Amentioning

confidence: 98%

“…They demonstrated that in patients with type 2 diabetes there are no differences in ejection fraction and left ventricular volumes as compared to gender-matched controls without diabetes [130]. However, in diabetic men the rate of subjects with an abnormally low ejection fraction was fourfold that among non-diabetic controls; this difference was not registered in women [130]. In this study, gated SPECT was performed with the clinical aim of examining myocardial perfusion, but the authors' research interest was focussed on the functional data alone, and the perfusion pattern was considered just to exclude the presence of myocardial infarction or stress-induced ischaemia.…”

Section: Gated Spect For the Evaluation Of Left Ventricular Volumes Amentioning

confidence: 99%

“…Finally, Htay et al compared the functional parameters derived from gated SPECT in diabetic patients with those obtained in patients with a low-to-intermediate probability of coronary artery disease, who had been submitted to reststress myocardial perfusion imaging in the emergency department because of non-specific symptoms [130]. They demonstrated that in patients with type 2 diabetes there are no differences in ejection fraction and left ventricular volumes as compared to gender-matched controls without diabetes [130].…”

Section: Gated Spect For the Evaluation Of Left Ventricular Volumes Amentioning

confidence: 99%

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The expanding role of left ventricular functional assessment using gated myocardial perfusion SPECT: the supporting actor is stealing the scene

Sciagrà

2007

Eur J Nucl Med Mol Imaging

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Background Gating of single-photon emission computed tomography (SPECT) has significantly improved the reliability and diagnostic accuracy of myocardial perfusion imaging. The functional parameters derived from this technique, mainly left ventricular volumes and ejection fraction, have been demonstrated to be accurate and reproducible. They are able to increase the detection of severe and extensive coronary artery disease and show a significant incremental prognostic power over perfusion abnormalities. Therefore, the importance given to gated SPECT functional data has progressively grown. Discussion This circumstance has further expanded the indications for myocardial perfusion imaging and strengthened its position among the different imaging modalities. Moreover, several studies show that the evaluation of ventricular function may have a leading part in justifying the execution of perfusion scintigraphy in various clinical conditions. Aim Aim of this review is to describe this evolution of gated SPECT functional assessment from a supporting rank with respect to perfusion, to a main actor position in the field of cardiac imaging.

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“…In a study that excluded patients with perfusion abnormalities, men with DM had a 4.4-fold increased risk of depressed LVEF (\45%) while this was not seen in women. 38 The reason for this gender discrepancy is not clear.…”

Section: Imaging For Myocardial Dysfunction In Dmmentioning

confidence: 95%

Cardiovascular imaging in diabetes mellitus

Hage

Iskandrian

2011

Journal of Nuclear Cardiology

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In the United States, over one third of the population has either diabetes mellitus (DM) or prediabetes (9% with DM and 26% with impaired fasting glucose). 1 DM is a major risk factor for cardiovascular (CV) events, and CV disease constitutes the leading cause of death in patients with DM. Furthermore, since DM patients without known coronary artery disease (CAD) have equivalent cardiac mortality to non-DM patients who have had a myocardial infarction (MI), clinical practice guidelines have considered patients with DM to be in the highest risk category (CAD risk equivalent). 2 DM is also associated with changes in cardiac structure and function. Both left ventricular (LV) systolic and diastolic functions have been shown to be altered in the presence of DM even in the absence of hypertension or myocardial ischemia. 3 Indeed, data going back to the Framingham Heart Study suggested that DM resulted in a 2-5 fold increased frequency of heart failure (HF). 4 This association has now been reproduced in independent studies and persisted even after controlling for multiple risk factors for HF, and DM is a predisposing factor for the development of LV systolic and diastolic dysfunction. 5,6 DM also affects the vascular endothelium. A central component of vascular disease in DM is endothelial dysfunction which is known to occur in patients with overt DM and in those with insulin resistance. 7 Imaging has thus taken a central role in the assessment of CV health and in the diagnosis, evaluation, and management of CV diseases in DM. CV IMAGING IN SYMPTOMATIC PATIENTS WITH DMRisk stratification is paramount in patients with DM due to the increasing proportion of the population that suffers from DM and since not all patients with DM have a similar CV risk. Diagnosing CAD in patients with DM is in itself a prognostic marker, since diabetics with CAD fare worse than those without known CAD. 2 Studies have examined the diagnostic capabilities of the various imaging modalities in this population and have shown generally similar sensitivity and specificity for the detection of CAD as in the general population. 8-10 It is important to mention that the gold standard against which most of these modalities were compared is invasive coronary angiography. This 'gold standard' evaluation of coronary anatomy is however not an ideal assessment of the diagnostic accuracy of imaging modalities that assess myocardial ischemia such as stress myocardial perfusion imaging (MPI) and 2-dimensional echocardiography (2DE), especially in patients with DM where small-vessel CAD is known to be prevalent. Another limitation suffered by most of these studies is the referral bias, which artificially lowers the specificity of these tests.Beyond their diagnostic accuracy multiple imaging modalities have been evaluated for their power in predicting CV events. Functional imaging modalities that can detect myocardial ischemia have shown good prognostic value in predicting the occurrence of future events. 11-14 Consistent across studies, DM patients with abnormal...

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Left ventricular function in patients with type 2 diabetes mellitus

Cited by 10 publications

References 20 publications

Diabetes reduces left ventricular ejection fraction-irrespective of presence and extent of coronary artery disease

Diabetes reduces left ventricular ejection fraction-irrespective of presence and extent of coronary artery disease

The expanding role of left ventricular functional assessment using gated myocardial perfusion SPECT: the supporting actor is stealing the scene

Cardiovascular imaging in diabetes mellitus

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