Mechanism of Impaired Left Ventricular Wall Motion in the Diabetic Heart Without Coronary Artery Disease

Sakamoto, Kenji; Yamasaki, Yuichiro; Nanto, Shinsuke; Shimonagata, Tsuyoshi; Morozumi, Toshiya; Ohara, Takahiro; Takano, Yuzuru; Nakayama, Hironobu; Kamado, Keiji; Nagata, Seiki; Kusuoka, Hideo; Nishimura, Toshihiro; Hori, Manabu

doi:10.2337/diacare.21.12.2123

Cited by 19 publications

(14 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In addition, other studies have shown changes of myocardial blood flow without alterations of myocardial oxygen consumption. Congruent with our findings of the dobutamine response, diabetic patients do not exhibit lactate production dur-ing atrial pacing [40]. In summary, although vascular structural and functional changes may be related to glycemic control, and some authors have connected these entities [32••,41], the balance of the data do not support vascular changes as the primary contributor to diabetic heart disease.…”

Section: Diabetic Vascular Diseasecontrasting

confidence: 77%

The diabetic myocardium

Marwick

2006

Curr Diab Rep

View full text Add to dashboard Cite

Heart failure and diabetes mellitus are frequently associated, with diabetes potentiating the development of heart failure after other myocardial insults. This review documents the evidence in support of a specific primary myocardial disease in diabetes. The strongest clinical evidence relates to the detection of otherwise unexplained diastolic dysfunction in apparently healthy diabetic subjects, but recent studies with sensitive echocardiographic markers have shown systolic disturbances as well. The mechanism of this myocardial disease is multifactorial, with contributions from metabolic effects on the myocyte, structural changes in the myocardium and interstitium, autonomic neuropathy, and perhaps coronary vascular disease. The common pathway appears to be related to glycemic control and new evidence suggests better metabolic control to be beneficial, as well as angiotensin-converting enzyme inhibition and cross-link breakers.

show abstract

Section: Diabetic Vascular Diseasecontrasting

confidence: 77%

The diabetic myocardium

Marwick

2006

Curr Diab Rep

View full text Add to dashboard Cite

show abstract

“…Various studies confirmed the occurrence of LV dysfunction in DM subjects; however the influence of DM on RV function is considered controversial and inconsistent. 4,5,27,28 Nevertheless it is unexpected for all these structural and functional changes to affect only the LV, whereas RV remains normal. In this study, we were able to show a significant impairment in RV function as well as LV function by using novel sensitive TDI-indices.…”

Section: Discussionmentioning

confidence: 99%

Impact of Myocardial Acceleration during Isovolumic Contraction in Evaluating Subclinical Right Ventricular Systolic Dysfunction in Type 2 Diabetes Mellitus Patients

et al. 2010

View full text Add to dashboard Cite

show abstract

“…® DM has been known to be an independent risk for congestive heart failure and depressed LV function, 1-3 which appears to be independent of coronary artery disease or other comorbid conditions. [3][4][5][6][7][8] There has been controversy, however, as to whether the occurrence of LV dysfunction in DM patients could be related to microvascular coronary abnormalities 9,10 or undiagnosed epicardial coronary artery disease. Thus, the abnormal flow in the small vessels may be pathogenetically involved in the cause of DM cardiomyopathy; however, decrease in RV function or isolated chronic right heart failure secondary to coronary artery disease does not exist.…”

Section: Discussionmentioning

confidence: 99%

“…

…”

mentioning

confidence: 99%

Presence of Biventricular Dysfunction in Patients With Type II Diabetes Mellitus

Movahed

Milne

2007

Congestive Heart Failure

View full text Add to dashboard Cite

Diabetes mellitus (DM) has been found to be an independent risk for congestive heart failure and depressed left ventricular (LV) function 1,2 and appears to be independent of other cardiovascular comorbid conditions. [2][3][4][5][6][7] The cause of diabetes cardiomyopathy is not known. We hypothesized that a direct negative effect of DM on the myocardial structure independent of coronary artery disease, should also involve right ventricular (RV) function. Except for one case report, 8 the occurrence of RV dysfunction in DM patients has not been studied. The goal of this study was to evaluate the occurrence of RV dysfunction in patients with DM. MethodsThis study was a retrospective analysis of data that was obtained from a series of 157 patients who underwent LV ejection fraction (LVEF) assessment using resting blood pool scintigraphy (multiple gated acquisition [MUGA]) for clinical reasons. The clinical indications of the study patients were not available. These patients underwent simultaneous measurement of RV ejection fraction (RVEF) and were predominantly men from a Veteran Administration hospital population.Using univariate analysis, we studied the correlation between DM and severely depressed LVEF and RVEF (defined as LVEF or RVEF <30%). This data was obtained during period of 2 years. The study sample size was based on the number of patients that were available during the study period. Using multiple regression analysis adjusting for coronary artery disease, hypertension, and chronic obstructive pulmonary disease, we evaluated the independent association of DM with severely depressed RV and LV function.MUGA Technique. The patients fasted for 4 hours before the study and had refrained from caffeine for 24 hours. They received an intravenous injection of 40 mg of stannous pyrophosphate in 1.5 mL saline. Ten minutes later, patients were positioned on the bed of the camera with the detector in the right anterior oblique position. A rapid bolus injection of 20 mCi technetium-99m pertechnetate was given intravenously, simultaneous with the start of a list mode acquisition. The study was presented as 1000 frames at 0.04 seconds per frame, in a 64×64 matrix. Following the first pass study and after time for equilibration in the blood volume, a standard gated cardiac blood pool study was performed in the anterior, left anterior oblique (LAO), and left lateral projections. The R-to-R interval was divided into 16 frames, not greater than 0.04 seconds in length. Acquisition was performed for 900 seconds in a 64×64 matrix. Quantitation was performed on the LAO view. Processing. RVEF Measurements.Frames showing maximum right ventricle activity were selected and summed into a single frame. This was used to draw a region of interest around the right ventricle. This region of interest was applied to the first Presence of Biventricular Dysfunction in Patients WithType (RVEF <30%; odds ratio, 5.7; confidence interval, odds ratio, 12.9; confidence interval,). These results suggest that diabetic cardiomyopathy involves bot...

show abstract

Mechanism of Impaired Left Ventricular Wall Motion in the Diabetic Heart Without Coronary Artery Disease

Abstract: Our findings suggest that impairment of myocardial FFA metabolism rather than small vessel abnormalities in the myocardium is responsible for modest left ventricular dysfunction in patients with diabetes.

Cited by 19 publications

References 17 publications

The diabetic myocardium

The diabetic myocardium

Impact of Myocardial Acceleration during Isovolumic Contraction in Evaluating Subclinical Right Ventricular Systolic Dysfunction in Type 2 Diabetes Mellitus Patients

Presence of Biventricular Dysfunction in Patients With Type II Diabetes Mellitus

Contact Info

Product

Resources

About