Preclinical abnormality of left ventricular performance in patients with insulin-dependent diabetes mellitus

Abstract

The left ventricular systolic function of 32 patients with insulin-dependent diabetes mellitus was investigated by measurement of systolic time intervals. Patients with clinical signs of sclerosis in the coronary arteries were excluded. Twenty-nine sex- and age-matched healthy people served as controls. Resting values of PEP/LVET ratio and of the corrected pre-ejection period were significantly higher in diabetics than in controls. The alterations of systolic time intervals during volume-loading induced by passive leg-raising as well as by isometric handgrip test indicated an increase in left ventricular performance in healthy people. The unchanged systolic time intervals observed in diabetics during the same loadings indicated a decrease in the functional reserve of the diabetic left ventricle. The systolic time intervals observed in patients with type-1 diabetes could be evaluated as a preclinical abnormality of left ventricular performance and as early signs of diabetic cardiomyopathy.

Left Ventricular Diastolic Dysfunction in Type 1 (Insulin-Dependent) Diabetic Patients during Dynamic Exercise

“…More conclusive results were obtained in this respect during exercise [6][7][8][9][10][11][12][13], Diastolic dysfunction of the left ventricle was also demonstrated in patients with dia betes mellitus. Several studies documented left ventricular diastolic dysfunction at rest [14][15][16][17][18][19][20][21][22] but a few reports were only pub lished about it during exercise [23].…”

The effects of passive leg raising on arterial wave reflection in healthy adults

“…PLR augments venous return, increases central venous and pulmonary pressures [1], and enhances LV preload and contractility [6,14,15]. These changes serve to increase stroke volume and cardiac output [5,7,15,16]. Intrathoracic blood pooling decreases sympathetic activity and increases parasympathetic activity, which in turn lowers heart rate (HR) [6,7].…”

“…These changes serve to increase stroke volume and cardiac output [5,7,15,16]. Intrathoracic blood pooling decreases sympathetic activity and increases parasympathetic activity, which in turn lowers heart rate (HR) [6,7]. BP responses to PLR measured at the brachial artery (BA) have been variable [11,[14][15][16].…”

“…Passive leg raising (PLR) is a simple diagnostic maneuver that has been used to assess baroreceptor function, detect subclinical left ventricular (LV) dysfunction, and unmask pulmonary hypertension [1][2][3][4][5][6][7][8][9]. Leg raising is one of the factors that distinguish upright and supine exercise, and is used to predict volume responsiveness and to increase blood pressure (BP) in hypotensive patients [10][11][12].…”

Effects of Ischemic Reperfusion Injury and Remote Conditioning on Passive Leg Raising-Induced Brachial-Artery Dilation

“…Passive leg raising (PLR) is a simple diagnostic maneuver that has been used to assess baroreceptor function, detect subclinical left ventricular dysfunction and unmask pulmonary hypertension [1,2,3,4]. Although PLR has been found to centralize blood volume, increase blood pressure (BP) and predict fluid responsiveness in critically ill hypotensive patients, the hemodynamic effects of PLR appear to be different in normotensive subjects [5].…”